******************************************************
Following are questions by Hon Cheung Kwok-che and a written reply by the Secretary for Labour and Welfare, Mr Matthew Cheung Kin-chung, in the Legislative Council today (July 3):
Question:
Some social workers have recently relayed that problems such as deteriorating functional capacity, cognitive impairment, swallowing difficulties and uncoordinated limbs of persons with intellectual disabilities (PIDs) will worsen with age, and that early onset of dementia and deteriorating functional capacity usually come very suddenly. Those social workers have also pointed out that since PIDs have difficulties in communicating with others and are unable to express their discomfort, it is difficult to assess the conditions of those persons suffering from dementia. In this connection, will the Government inform this Council:
(a) whether it has currently developed a tool for assessing dementia in PIDs; if so, of the details; if not, the reasons for that, and of the means currently adopted to assess whether a PID is suffering from dementia;
(b) as some social workers have pointed out that frontline healthcare manpower is currently insufficient to meet the service needs arising from the ageing of PIDs, whether the authorities will review and adjust the mode and staff establishment of existing services; if they will, of the details; if not, the reasons for that;
(c) of the objectives of the Social Welfare Department (SWD) in providing Dementia Supplement for Elderly with Disabilities (Supplement) for application by residential care homes for persons with disabilities (RCHDs), and the application requirements; the respective numbers of applications received, approved and rejected by SWD in the past two years, and the amount approved, with a breakdown by SWD district and type of residential care homes;
(d) as some social workers have relayed that over 40% of the PID residents in residential care homes showed symptoms of dementia when they reached 40 years old, but one of the application requirements for the Supplement is that the patient must be 60 years old or above, rendering residential care homes unable to apply for the Supplement to hire additional manpower for upgrading the care for such residents, whether the authorities will consider relaxing that application requirement; if they will, of the details; if not, the reasons for that;
(e) of the following figures in each of the past three years, broken down by the age group to which the PIDs belong (i.e. 20 years old or below, 21 to 30 years old, 31 to 40 years old, 41 to 50 years old, 51 to 60 years old and 61 years old or above):
(i) the number of trainees with intellectual disabilities, as well as the percentage of such number in the total number of trainees, in government-subvented day activity centres (DAC);
(ii) the number of trainees with intellectual disabilities, as well as the percentage of such number in the total number of trainees, in government-subvented sheltered workshops (SW);
(iii) the number of PIDs in RCHDs, with a breakdown by type of RCHDs; and
(iv) the number of PIDs who received services of integrated rehabilitation services centres (IVRSC), as well as the percentage of such number in the total number of persons receiving services of the centres;
(f) whether the authorities know the respective numbers and percentages of persons suffering from dementia in different types of RCHDs; if they do, of the details; if not, whether the authorities will collate such information;
(g) given that some trainees in DAC and SW are suffering from dementia, whether the authorities will consider setting up teams of professional staff (e.g. occupational therapists, physiotherapists, nurses and health workers) in DAC and SW to provide such trainees with suitable therapeutic exercises and healthcare services; and
(h) of the respective standards on staff establishment of RCHDs, DAC and SW in 1990, 1995 and 2000, with a breakdown by rank of staff?
Reply:
President,
My reply to the questions raised by Hon Cheung Kwok-che is as follows:
(a) Through multi-disciplinary teams comprising psychiatrists, psychiatric nurses, occupational therapists, medical social workers and clinical psychologists, etc., the Hospital Authority (HA) has been providing appropriate medical and rehabilitative care services to persons with intellectual disabilities according to their individual needs. In determining whether a person with intellectual disabilities is suffering from dementia, doctors will examine the patient's clinical symptoms and conduct blood test, mental and behavioral assessments, cognitive assessments, brain scans and magnetic resonance imaging scans as necessary before making the diagnosis and providing follow-up treatment where appropriate.
(b) & (g) In line with the service development direction of providing continuum of residential care for persons with disabilities, SWD has rolled out a number of measures since 2005 to meet the needs of ageing service users with deteriorating functional capacity. These include the launching of the Extended Care Programme (ECP) in DAC and the Work Extension Programme (WEP) in SW and IVRSC respectively in October 2005; and provision of additional recurrent funding of about $39 million since 2010 to enhance healthcare and physiotherapy services provided in hostels for moderately mentally handicapped persons and severely mentally handicapped persons.
In 2013-14, the Administration has earmarked an additional recurrent funding of $67.9 million to strengthen the manpower of residential care homes and day training centres for persons with disabilities with a view to enhancing the care for ageing service users. The allocation aims to facilitate the hostels for persons with intellectual or physical disabilities, SW/IVRSC operating WEP, and DAC operating ECP to obtain extra care staff. Under the Lump Sum Grant Subvention System, non-governmental organisations (NGOs) operating such residential care homes and day training centres for persons with disabilities have the flexibility in deploying the additional funding in arranging suitable staffing to ensure service quality and meet service needs.
SWD will continue to monitor the service demand and resource utilisation, and review the arrangements accordingly.
(c) & (d) The Dementia Supplement (the Supplement) introduced by SWD in 1999 is provided to subvented residential care homes to facilitate their employment of additional staff and/or procurement of relevant professional services for the care of their elderly residents suffering from dementia. Applications will be invited from subvented residential care homes for the elderly and RCHDs, which will conduct initial assessment for their elderly residents in accordance with a set of established criteria before seeking confirmation of their eligibility for the Supplement from the Psychogeriatric Teams (PGTs) or Community Psychiatric Teams (CPTs) of HA.
A total of 156 and 154 applications for the Supplement from RCHDs were received by SWD in 2012-13 and 2013-14 respectively. Upon confirmation of eligibility by HA's PGTs or CPTs, 143 and 141 eligible cases were approved, involving about $5.72 million and $5.67 million respectively. Apart from care and attention homes for the aged blind, other subvented RCHDs (such as hostels for severely mentally handicapped persons and care and attention homes for severely disabled persons) have also submitted applications for the Supplement having regard to the conditions of their service users.
For those persons with disabilities who cannot live independently or cannot be adequately cared for by their families, SWD provides a variety of subsidised residential care services to meet their diverse residential care needs at different stages. As mentioned in the reply to part (b) above, SWD has launched a number of measures since 2005 to meet the needs of ageing service users with deteriorating functional capacity. As regards the age limit of application for the Supplement, SWD will continue to monitor the service demand and resource utilisation, and review the arrangements accordingly.
(e) Given the lead time required for collating the data, SWD at present can only provide the age profiles of service users of DAC, SW and various types of RCHDs as at the end of 2012. The relevant information is detailed at Annex 1 and Annex 2.
SWD does not have the requested statistics in relation to IVRSC as these centres may admit service users directly or by referral.
(f) SWD does not have the statistics on the number and percentage of persons suffering from dementia among residents of RCHDs.
(h) Under the Lump Sum Grant Subvention System, NGOs have the flexibility in deploying the allocated provision to arrange suitable staffing to ensure service quality and meet service needs. The notional staff establishment of various types of rehabilitation services in the past can be found in the Handbook on Rehabilitation Services which is available on the website of SWD.
Ends/Wednesday, July 3, 2013
Issued at HKT 12:50
NNNN
