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LCQ11: Support for infirm and demented elders staying in subsidised residential care places

     Following is a written 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 (May 20):


     I have often received complaints from frontline workers of subvented care and attention homes for the elderly (C&AHs) that many residents of these homes are in need of nursing or infirmary care services, yet there is a shortage of manpower due to insufficient government funding, which seriously affects the quality of service and increases frontline workers' risk of sustaining injuries.  Although in the current financial year, the authorities have provided additional funding of $37 million to residential care homes for the elderly for taking care of infirm elderly residents and those with dementia, the provision is only a drop in the bucket and far from enough for meeting the extra expenses for taking care of these residents.  In this connection, will the Government inform this Council:

(a) whether it knows the respective current numbers of subvented C&AH residents who are in need of infirmary care services, those who are in need of nursing care services and those with dementia;

(b) of the respective amounts of Infirmary Care Supplement and Dementia Supplement granted by the Government in 2008-2009; the respective names of the C&AHs which were granted the highest and the lowest amounts of such supplements, the amounts involved and the numbers of these two categories of residents in those C&AHs; what criteria the Social Welfare Department has adopted for determining the amounts of supplements granted to various C&AHs; whether the percentage of the amounts of supplements granted in the total subvention is the same for various C&AHs; and why the Government did not grant the supplements to C&AHs according to the number of the residents concerned;

(c) whether it will grant subvention to C&AHs according to the cost of each nursing home place (i.e. $12,609 per month) and the number of residents in need of nursing care service; if so, when it will be implemented; if not, of the reasons for that; and

(d) as the Report of the Director of Audit on the results of value for money audits published in March 2002 pointed out that the cost of a nursing home place for caring an elderly resident in need of infirmary care service amounted to $18,625 a month, whether the Government will grant subvention to subvented C&AHs and nursing homes based on this amount and the number of residents in need of infirmary care service; if so, when it will be implemented; if not, of the reasons for that?



      My reply to the four parts of Hon Leung Kwok-hung's question is as follows:

(a) to (b) To enhance the support for infirm and demented elders staying in subsidised residential care places, the Government has since 1995-96 provided Infirmary Care Supplement (ICS) to residential care homes for the elderly (RCHEs).  The Government also provides Dementia Supplement (DS) to RCHEs since 1998-99.  RCHEs can make use of these supplements to employ additional staff, including physiotherapists, occupational therapists, nurses (registered or enrolled nurses), health workers and care workers, etc. to enhance the care for needy elders.

     On ICS, the eligibility of elders for the supplement is assessed by the Hospital Authority (HA)'s Community Geriatric Assessment Teams (CGATs).  The Social Welfare Department (SWD) then allocates ICS to individual RCHEs according to the number of eligible elders confirmed by HA every year.  Eligibility for ICS was extended to private RCHEs participating in the Enhanced Bought Place Scheme (EBPS) in 2003-04.   

     On DS, SWD invites applications from subsidised RCHEs and HA's Psychogeriatric Teams (PGTs) assess the eligibility of those elders for DS.  SWD then allocates DS to individual RCHEs based on the number of eligible elders confirmed by HA every year.  In 2009-10, eligibility for DS was extended to private RCHEs participating in EBPS.  

     In 2008-09, the total amount of ICS allocated was $45.4 million, providing additional support for a total of 1 226 elders.  The total amount of DS allocated was $24.3 million, benefiting a total of 2 542 elders.

     To further strengthen the support for these elders, the Government has provided additional recurrent funding of $20 million as ICS and $17 million as DS in 2009-10.  The total provision for ICS and DS has significantly increased by 44% and 70% respectively compared with that in 2008-09.

(c) As at March 2009, about 170 elders (less than 1%) out of some 20 000 elders staying in subsidised care-and-attention places were waiting for subsidised nursing home places.  Apart from ICS and DS mentioned above, the Government has been supporting RCHEs in many ways to enhance their capability in taking care of elders.  In particular, doctors and nurses of HA's CGATs and PGTs, as well as the Department of Health (DH)'s Visiting Health Teams, pay regular visits to RCHEs to provide medical assessments and support services for elderly residents in need.  Community nurses will also provide on-site nursing care for elderly residents to ensure that they receive appropriate care.

(d) The Director of Audit recommended in his Report No. 38 published in 2002 that the then Health and Welfare Bureau should consider whether infirmary care should be provided in a welfare institution setting instead of in a hospital setting.

     Drawing reference to the Audit Commission's recommendation, SWD proposed to launch a trial scheme to provide subsidised infirmary care services for medically stable frail elders in purpose-built RCHE premises.  Taking into account the opinion of the welfare sector, the Government considered that upgrading some of the places in existing subvented RCHEs to provide infirmary care services might be more cost-effective.  In 2007 and 2008, SWD discussed with the sector details of the upgrading plan, including the increase of subsidy amount and other requirements (especially manpower requirements for nurses).  However, the sector indicated that they were not able to employ adequate nurses to fulfill DH's licensing requirements owing to the shortage of nurses (especially registered nurses).  SWD is exploring other options, and at the same time, organising enrolled nurse training programmes in collaboration with HA.  In addition, in view of the acute demand for registered nurses in both public and private health care institutions as well as in the welfare sector, the University Grants Committee has adopted the Government's advice to increase study places for nursing in its institutions.  HA will also continue to organise the higher diploma nursing programme in three hospitals with a view to increasing the supply of nurses.  

Ends/Wednesday, May 20, 2009
Issued at HKT 13:24


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