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LCQ1: Subsidised nursing home places

     Following is an oral reply by the Secretary for Labour and Welfare, Mr Matthew Cheung Kin-chung, to a question by the Hon Leung Kwok-hung in the Legislative Council today (March 18):


     Some elderly people and organisations have complained to me that the current acute shortfall of subsidised nursing home (NH) places has resulted in rather long waiting time for such places.  Moreover, due to the lack of necessary ancillary facilities, the care and attention homes and private homes for the elderly which have participated in the Enhanced Bought Place Scheme are unable to take proper care of elderly people who need intensive care, and the current subsidised Integrated Home Care Services (IHCS) have also failed to provide proper care for such elderly people.  In this connection, will the Government inform this Council of:

(a) the current respective numbers of elderly people waiting for subsidised NH places who live in the community and private homes for the elderly, together with a breakdown of the average waiting time for such places by District Council districts (excluding cases of the elderly people concerned choosing to wait for admission to specified homes and those cases which were given priority allocation on grounds of special circumstances);

(b) the number of elderly people in each of the past five years who died while waiting for NH places, and whether the Government will substantially increase such places to ease the current situation of supply falling short of demand; if so, when it will be implemented; if not, the reasons for that; and

(c) the details of IHCS currently provided by the Social Welfare Department (SWD) for singleton elderly people who live in the community and are waiting for subsidised NH places, the average waiting time for such services, and the daily number of hours of such services which can be provided to the elderly people; whether SWD has assessed if such services can meet their needs; if assessment has been conducted, of the findings; if not, the reasons for that?



     Promoting "ageing in the community" is one of the underlying principles of the Government¡¦s elderly policy, and hence we have allocated considerable resources to support elders to age in the community. I have to emphasise that not all elders with long-term care (LTC) needs have to stay in residential care homes, and not all elders with LTC needs require subsidised residential care services. With adequate community care and support, elders with LTC needs can continue to age at home as they wish.

     Now, I will reply the three parts of Hon Leung Kwok-hung¡¦s question individually.  

(a) As at end-January 2009, a total of 6 267 elders were waiting for government-subsidised nursing home (NH) places.  Among them, 1 838 elders were living in the community, 3 726 elders were living in private residential care homes for the elderly (RCHEs) and the remaining 703 elders were living in various kinds of subsidised or self-financing RCHEs or hospitals.

     As shown in the above-mentioned figures, some elders waiting for subsidised NH places are already occupying government-subsidised care-and-attention (C&A) places. They can also opt for government-subsidised community care services in the interim.  Generally speaking, elders can be allocated with subsidised community care services that suit their needs within a relatively short period of time. Besides, some elders may choose to stay in private RCHEs while waiting. If these elders require financial assistance, they may apply for Comprehensive Social Security Assistance (CSSA) to meet the relevant expenses.

     As at end-January 2009, about 3 543 elders on the waiting list were receiving various kinds of government subsidies or services, including:

(i) about 638 (i.e. 10.2%) were using subsidised community care services;

(ii) about 185 (i.e. 3%) were using subsidised residential care services of a lower care level; and

(iii) about 2 720 (i.e. 43.4%) were staying in non-subsidised residential care places in private RCHEs and are receiving CSSA.

     Regarding the waiting time, as the overall planning and service allocation of subsidised NH places are based on territory-wide demand, the Social Welfare Department (SWD) cannot provide information on the waiting time by district.  Excluding cases where elders have specific requirements on the RCHEs they are waiting for (such as requesting for particular RCHEs or specific location of RCHEs) as well as the priority cases, the average waiting time for subsidised NH places is 40.5 months, which is similar to the overall average waiting time of 40 months.
(b) The numbers of elders who passed away while waiting for subsidised NH places in the past five years were 1 293, 1 339, 1 540, 1 619 and 1 847 respectively.

     The Government has made every effort to respond to the demand of elders for subsidised NH places.  In recent years, the Government has been increasing the supply of subsidised NH places mainly through the construction of contract RCHEs.  At present, there are a total of 16 contract RCHEs in Hong Kong.  Among them, 14 have obtained RCHE licences and NH licences from SWD and the Department of Health respectively, and can therefore provide both subsidised C&A places and NH places.  We will continue to provide contract RCHEs with both NH places and C&A places, and will also increase the number of subsidised NH places to meet the demand of the elderly.  Besides, the C&A places in contract RCHEs provide continuum of care, i.e. elders can continue to stay in the same RCHE instead of moving to another NH when their health deteriorates to a level that requires nursing care.  On top of subsidised places, contract RCHEs also provide non-subsidised residential care places which can take care of elders requiring C&A or nursing level of care, offering elders another option besides subsidised places.

     Regarding the number of places, there are at present 2 086 subsidised NH places and 1 289 self-financing places which can take care of elders requiring nursing level of care. The contracts of another two newly built RCHEs have just been awarded by SWD at the end of 2008, the renovation works of which will start shortly. These two new contract RCHEs will provide 99 subsidised NH places, 43 subsidised C&A places and 98 non-subsidised residential care places.  In sum, through the provision of contract RCHEs, the Government has increased the supply of subsidised NH places from 1 574 in 2003-04 to 2 086 at present, representing an increase of 33%.  In addition, SWD will conduct open tender exercises to select operators for five newly built contract RCHEs from now till 2011-12.  A total of 230 subsidised NH places will be provided in these RCHEs.  Besides, SWD has earmarked sites in 12 development projects for the construction of new contract RCHEs, and will proceed with the open tender process in phases to select operators for these RCHEs upon the completion of construction.

     To further increase the supply of subsidised NH places, enhance the support for elders requiring nursing level of care, and expedite the commencement of services of newly built contract RCHEs, SWD will adopt a series of measures including:

(i) to continue to identify suitable sites for the construction of new contract RCHEs;

(ii) to explore the possibility of in-situ expansion of existing contract RCHEs to increase the provision of subsidised NH places;

(iii) to identify ways to further expedite the work process in collaboration with the Housing Department (HD) and relevant departments to facilitate the early operation of newly built contract RCHEs located in HD¡¦s public housing estates; and

(iv) to continue with the Conversion Programme to convert in phases subsidised places without LTC element into places that provide continuum of care up to nursing level, so that elders can continue to stay in a familiar environment when their health deteriorates to a level that requires nursing care, instead of waiting for subsidised NH places afresh.

(c) We encourage and support elders with LTC needs, including elders who are waiting for C&A places or NH places, to age at home, and we provide them with a wide range of subsidised community care services through non-government organisations.  These services include home-based Integrated Home Care Services (IHCS) and Enhanced Home and Community Care Services (EHCCS), as well as centre-based day care services for the elderly.

     The home-based community care services enable elders to receive nursing and care services in a familiar home and community environment, and at the same time provide support to their carers with a view to achieving the goal of enhancing family cohesion and meeting the wishes of frail elders to age in the community.  The home-based community care services include personal care (e.g. feeding and bathing), basic nursing care (e.g. measuring blood pressure and body temperature), special nursing care (e.g. incontinence care, diabetic care, respiratory care and infection control), rehabilitation training, meals delivery, household cleaning and escort services, etc.

     Currently, the 60 IHCS teams and 24 EHCCS teams in Hong Kong provide a service capacity of 4 586 cases for elders with LTC needs, including the additional service capacity of 810 cases provided by the six new EHCCS teams set up in December last year.  At present, the waiting time for community care services in different districts varies, from no waiting at all to several months, and the average waiting time is less than three months. We expect that the waiting time will be further reduced upon the full implementation of the new service teams.

     Since the condition of every elder receiving community care services is different, to ensure that the elders are provided with the most suitable care, the social workers or case managers in-charge will tailor-make for each elder a set of systematic individual care plan, which includes setting service targets and determining the types of services, service frequency and service hours.  In respect of service hours, taking the figures of the 4th quarter of 2008 as an example, operating organisations provided to each elder quarterly 44 to 60 hours of direct care services (e.g. special care, rehabilitation exercises, bathing, measuring body temperature and blood pressure etc.), according to the needs of individual elders.  These have yet to include the hours of support services, such as meals delivery, household cleaning, counselling, escort and respite services.

     In addition, the responsible social workers will consult the healthcare professionals and para-medical professionals taking care of the elders, their family members and the elders themselves to regularly or at least annually review the service hours and nature, so as to cater for the needs of every single elder.

Ends/Wednesday, March 18, 2009
Issued at HKT 13:04


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