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Following is a speech on Long Term Care for Elders in Hong Kong by the Secretary for Health and Welfare, Dr E K Yeoh, at the First World Congress on Long Term Carein Chinese Communities today (March 22):

Dr Leung, distinguished guests, ladies and gentlemen,

I am delighted to be here today to address this distinguished audience - comprising experts in long term care for Chinese communities from all over the world.

We in Hong Kong are very happy to share our experiences in developing and establishing an integrated, client-centred and sustainable long-term care system. I would like to start by giving you an overview of our policy on care for elders.

Like many other places in the world, Hong Kong's population is ageing. The proportion of the population aged 65 or above will grow from 11.2 per cent in 2001 to 15.7 per cent in 2021. That is, by 2021, over 1.3 million, or one out of six Hong Kong people will be aged 65 or above.

In 1997, the Chief Executive of the Hong Kong Special Administrative Region designated 'Care for Elders' as one of the strategic policy objectives, with the aim of improving the quality of life of our elders and providing them with a sense of security, a sense of belonging, and a feeling of health and worthiness. In the same year the Chief Executive established the Elderly Commission, which comprises professionals, academics, and service providers, to advise the Government on policies and services for elders.

Over the past few years, the Elderly Commission has focused its attention on a wide spectrum of subjects, including provision of suitable housing, and residential and community care to meet the changing needs of our elders. The Government has substantially increased expenditure for elders. We propose to spend $3.5 billion on services for elders in 2002-03, which more than doubles the amount we spent five years ago.

Most of the elders in Hong Kong are healthy. We expect our next generation of elders will live longer, and be healthier, better educated and financially more secure. Our paramount task, therefore, is to dispel the common misconception that ageing is inevitably associated with physical and mental decline. We need to improve the community's understanding of ageing as a natural, continuous and positive process. Our social-economic institutions need to be transformed to cater for the changes generated by an ageing population.

We have started and will continue to promote the concept of healthy ageing in the community, and among different sectors, using a life-course approach. Our focus is on both physical and psychosocial well-being. The target group comprises not only the older persons, but also the soon-to-be old. By emphasizing healthy lifestyles, disease prevention, lifelong learning, and supportive environments that maximize independence and encourage continuous growth, we aim to reduce and delay the number of people becoming functional dependent, and requiring long term care.

Nevertheless, with an ageing population, the absolute number of elders who require care on a long-term basis 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. The objective of our long-term care programme is to provide quality and cost-effective care for our frail elders, and appropriate support for their carers.

In Hong Kong, as in other Chinese communities, there is a strong tradition of families taking care of their elders. Nearly 70 per cent of our older persons live with their children. We highly treasure this tradition, and will continue to reinforce it through our fiscal and other policies. The provision of formal care is to complement, not replace, the support system of families and friends.

Our long-term care system is structured around two main forms of care delivery: community and residential care. Together, the community and residential care programmes offer older people and their families a broad range of services and support, depending on their needs and circumstances.

To ensure our resources target at those elders most in need, Hong Kong has adopted a standardized care need assessment tool for all elders who apply for subsidized long term care services. The tool has achieved several objectives: more precise matching of services to care needs; helping to establish a single entry point for all subsidized community and residential care services; and the assessment results provide the basis for individual care planning for elders receiving the services.

We are moving to a more appropriate mix of care from institutions towards the community. This shift of emphasis means whenever possible, older people are assisted to stay in their own homes, where they prefer to be. At the same time, by supporting families to take care of their older relatives at home, we strengthen family cohesion.

In the coming years, as a viable alternative to institutional care, we will continue to expand the enhanced community care services. These services come in the form of individually tailored packages, for frail older people assessed to require a range of services in their own homes.

We will also continue to build integrated facilities in the community, to provide at one stop the services and support required by families to look after their frail elders at home. The range of services available for carers includes day and residential respite for elders, carer support centers, and provision of information, training and emotional support.

When frail, older people can no longer be assisted to stay in their homes, care is available in residential care homes. Residential care in Hong Kong is provided by both non-governmental organizations (NGOs) and the private sector. It is our objective to continue to improve cost-effectiveness and increase users' choice, via this mixed mode of service provision.

Within residential care, we are moving towards integrating the various levels of long term care traditionally provided by different institutions. Instead of building different categories of homes, ranging from home for the aged, care and attention home, and nursing home, the idea is to build 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. This will remove the need for elders to move from one institution to another upon deterioration of their health. In this context, we will also explore the most appropriate setting to operate infirmary services, which now come under hospital care.

With the progressive introduction of the 'continuum of care' concept in both the community and residential care settings, adequate medical and allied health support will become very important. We will continue to explore and pursue initiatives to improve the interface between the medical and health, and the social welfare sectors.

Like many other places with an ageing population, Hong Kong is seeking ways to address the common concern of long term care financing. In the short term, we will respond to new demands by enhancing value for money and improving services. We will continue to re-engineer and innovate existing services, to ensure they are targeted, appropriate and cost-effective.

In parallel, we will continue to mobilize community resources, to provide better support to frail elders and their family carers. For example, we have set up 36 support teams throughout Hong Kong to provide social networking and outreaching services to vulnerable elders. The teams also develop senior volunteer programmes to encourage elders to take part in volunteer work. Over 10,000 elders have been recruited as volunteers.

For the medium term, we are exploring options, including the setting up of a new subsidy arrangement for the residential care programme, which allows elders more say in the choice of care homes, flexibility to contribute more to their own care costs, and a quick access to such service.

To create an environment for the subsidy programme, we are pursuing a number of initiatives to improve the supply of quality private residential care homes in the market. Let me quote a few examples -

* We have commissioned the Hong Kong Association of Gerontology to conduct a two-year pilot study on development and establishment of an accreditation system for care homes in Hong Kong, with the objective of raising quality of service.

* We are selecting operators through open tendering, inviting both NGOs and private operators to participate in the provision of quality subsidized and non-subsidised places, in all new Government purpose-built care home premises.

* We are developing a scheme to encourage private developers to provide purpose-built care home premises in their new developments, targeting at elders and their families who are able and are prepared to pay market determined rates.

In the longer term, we will explore a more rational and effective basis for funding long-term care services. We will also have to study how the long-term care system should be financed, including the possibility of introducing a long-term care insurance scheme.

We should not lose sight of our goal in long term care - which is to improve the quality of life of our elders. Our belief is there are always ways to facilitate elders to remain productive and participating members of our community. Even when we cannot reverse the elders' chronic health conditions or functional dependency, there is room for innovation to optimize their functional abilities, and to help them regain self-esteem, feeling of control and sense of coherence.

We have already set a very clear direction towards achieving our policy objectives and we have made remarkable progress. In the next few years, we will pursue the following key initiatives -

* With the use of the standardized care need assessment tool, we will seek to make more precise matching of services to care needs and establish a single entry point for all subsidized community and residential care services.

* We will move to a more appropriate mix of care from institutions towards the community.

* We will move towards integrating the various levels of long term care traditionally provided by different institutions and build only one type of residential care home in future, which will provide continuum of care services, to cater for elders of different care needs at different stages of their lives.

* In the context of developing the concept of "continuum of care", we will explore the most appropriate setting to operate infirmary services, which now come under hospital care.

* We will explore options, including the setting up of a new subsidy arrangement for the residential care programme, which allows elders more say in the choice of care homes, flexibility to contribute more to their own care costs, and a quick access to such service.

I have just outlined our policies on long term care for elders in Hong Kong. We have studied extensively overseas experiences in providing long term care for elders, and have drawn reference from such experiences where applicable. Today is a valuable occasion for us to get an update on what is happening around us in other parts of the world. The discussion will be particularly useful, as we will be learning from the various models of care in Chinese communities. I would welcome your views and suggestions on any aspect of our policies and programmes.

Thank you.

END/Friday, March 22, 2001

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