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Following is a question by the Hon Fernando Cheung and a written reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (May 2):
Question:
Under the Visiting Medical Officer/Community Geriatric Assessment Team Collaborative Scheme launched by the Hospital Authority (HA) in October 2003, medical staff are dispatched to residential care homes for the elderly (RCHEs) to provide them with regular multi-disciplinary outreach medical consultation and after-care services (outreach services). It has been reported that the Health, Welfare and Food Bureau has imposed a cap on such services in order to control expenditure and the RCHEs being denied such services are all privately-run institutions. In this connection, will the Government inform this Council:
(a) among the residents presently staying in private RCHEs and subsidized RCHEs, of the respective numbers and percentages of elderly persons whose levels of impairment have been assessed as "mild", "moderate" and "severe" under the Standardized Care Need Assessment Mechanism for Elderly Services;
(b) of the respective numbers of visits to private RCHEs and subsidized RCHEs by the medical staff, the respective numbers of attendances by elderly persons for outreach services, as well as the annual expenditure and unit cost of such services, in each of the past five years; and
(c) of the respective numbers of applications by private RCHEs and subsidized RCHEs for outreach services rejected in each of the past five years, the reasons for rejection and their percentages among all such applications?
Reply:
Madam President,
The Administration's subvention to the Hospital Authority (HA) for 2007-08 is estimated to be $28.63 billion, representing an increase of roughly 2.4% when compared to the revised estimate of $27.96 billion for 2006-07. The subvention is in the form of a block grant for HA's deployment.
HA's Community Geriatric Assessment Teams (CGATs) have been providing outreach medical consultation and after-care services to the elders in residential care homes for the elderly (RCHEs) since 1994. In October 2003, HA implemented the Visiting Medical Officer/CGAT Collaborative Scheme (the Collaborative Scheme) to recruit private medical practitioners on a part-time basis to render support to the CGATs by helping out with the outreach work in RCHEs. Given the difficulty in recruiting private medical practitioners to participate in the Collaborative Scheme, at present HA mainly recruits qualified medical graduates on a contract and full-time basis to help out with the outreach work in RCHEs to render support to the CGATs.
My replies to the specific questions are as follows:
(a) The requirement for applicants of the subsidised long-term care services to undergo the Standardised Care Need Assessment (the Assessment) to ascertain their impairment levels for service matching (including community care services and/or subsidised residential care places) was introduced in November 2000. Elders who were admitted to subsidised residential care places prior to that date were not required to go through the Assessment. With the Assessment in place, all the applicants for the government-subsidised residential care places and the self-financing places in contract homes have to be assessed, but not for those applying for self-financing places not in contract homes. Against this background, the Social Welfare Department (SWD) can only provide information on the impairment levels of elders who have gone through the Assessment and are currently staying in the government-subsidised residential care places and the self-financing places in contract homes, as shown in Annex 1.
(b) HA does not have records on the number of visits to RCHEs by the CGATs and the Visiting Medical Officers (VMOs) of the Collaborative Scheme in each year. The statistics on the number of attendances are however available.
The number of attendances served by the CGATs at the private and subsidised RCHEs respectively in the past five financial years is shown in Annex 2.
Since October 2003, the VMOs of the Collaborative Scheme have taken on the number of attendances shown in Annex 3. HA does not have a breakdown on the attendances in terms of the types of RCHEs. However, we believe that the majority of them was taken up by elders in private RCHEs.
The CGATs also provide in-patient services in hospital wards apart from the outreach support to RCHEs. HA does not have a breakdown on the cost of CGAT's outreach services to the RCHEs alone. Only the overall cost of the CGATs' services is available. The total costs for the CGATs and the Collaborative Scheme in each of the past five financial years (counted since October 2003 for the Collaborative Scheme) are shown in Annex 4.
The above statistics show that, in the past five financial years, HA has allocated additional resources each year to strengthen the outreach services. Also, there has been an increase in the total number of attendances.
(c) At present, most of the RCHEs have made their own arrangements to appoint private medical practitioners to provide medical care to their residents in accordance with the advice laid down in the Code of Practice for Residential Care Homes for the Elderly issued by SWD. The CGATs and the Collaborative Scheme are currently providing outreach services to some 660 RCHEs (i.e. 89% of all the RCHEs). In view of the growing number of RCHEs, the CGATs and the Collaborative Scheme were unable to provide services to about 50 RCHEs which had asked for the services in the past few years.
Ends/Wednesday, May 2, 2007
Issued at HKT 12:29
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