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Speech by SLW at 8th World Congress on Long Term Care in Chinese Communities and Asian Ageing Development Conference (English only)

     Following is the speech by the Secretary for Labour and Welfare, Mr Matthew Cheung Kin-chung, at the 8th World Congress on Long Term Care in Chinese Communities and Asian Ageing Development Conference "3As in Aged Care - Advocacy, Advancement and Achievement" today (November 24):

Dr (Edward) Leung, distinguished guests, ladies and gentlemen,

     It is my pleasure to be here today to address this conference, which brings together experts and professionals in elderly care from around the world. Let me extend a very warm welcome to you all, especially our overseas delegates.  

     The 1st World Congress on Long Term Care in Chinese Communities and Asian Ageing Development Conference was held in Hong Kong eight years ago in 2002. My warm thanks to the Hong Kong Association of Gerontology (HKAG) for bringing this conference back to town. This event also marks the Silver Jubilee of the HKAG. Over the past 25 years, the HKAG has been instrumental in enhancing public awareness of the issue of ageing. This has greatly facilitated the work of the Hong Kong Government in devising long-term care policies and for this we are most grateful.

Ageing population

     The population is ageing fast in many developed economies. Hong Kong is no exception. I am pleased to say that Hong Kong now ranks first in male life expectancy and comes second only to Japan for females. However, quite disappointingly, our fertility rate is among the lowest. The combination of these two factors has resulted in Hong Kong being one of the fastest ageing places in the world. Today, one in eight of our population is an elder aged 65 and above. In less than 20 years' time, the ratio will double to one in four.  Such a demographic transformation presents tremendous policy challenges for Hong Kong in the provision of long-term care services. How best can we meet the needs of our elderly? How can we provide the best support to our ageing population without placing an undue burden on the younger generation? How can we make sure that our long-term care is sustainable? As a responsible, responsive and caring Government, we must think hard about these questions and plan now for the needs of our society in the years and decades ahead.
Long-term care services in Hong Kong

     The Hong Kong Special Administrative Region (SAR) Government strives to provide quality and cost-effective long-term care for our elderly population.  Our services are broadly divided into two streams - that is community care services covering day care and home care; and residential care services. We fund both streams of services by subsidising the operators, which are mostly non-governmental organisations (NGOs).

     As a matter of policy, we encourage elders to age in place (i.e. at home and in the community). The reason is simple. Just ask yourself: do you want to stay at home when you grow old or do you prefer moving into an institution? The answer is obvious. There is just no place like home. However, in Hong Kong, some 7 per cent of our elders are institutionalised. This is well above the average rate of institutionalisation in Asia and indeed most advanced economies around the world. Why is that so?

     Our Elderly Commission, led by Professor Alfred Chan, has provided us with an answer after conducting two comprehensive studies on long-term care services in Hong Kong. Over the years, we have been investing heavily in residential care services and understandably so. As a result, Government expenditure in this area (at HK$2,549 million) in 2010-11 was seven times higher than that on community care services. There is thus an imbalance in financial provision for these two streams. Many of our elders and their families know little about the community care available to consider it a viable option.  Admittedly, they are not to blame because the existing provision of community care service is simply far from mature and adequate. When their health conditions deteriorate, very often they can only think of one solution: a residential care home.

     To give our elders more choices, we are taking a number of bold steps to reform our system.

Pilot scheme on community care service voucher

     First of all, we decided to break away from the traditional funding and service delivery modes and introduce a pilot scheme on community care service vouchers. In short, money will follow the service users, not the service providers. By providing subsidies directly to elderly people, we empower them to make their own decisions: they can choose the service provider and service content which best suit their needs.  This concept of empowerment is crucial as it is the driving force for service providers to offer the best quality and most cost-effective service for our elders. We hope that our elders and their families will see community care as a desirable alternative to residential care and make wise choices.

     On the supply side, community care service is mainly provided by Government-funded NGOs. There are very limited self-financing services and private market participation. A voucher system will encourage different types of service providers to join the market. The result will be a much more diverse and innovative community care sector. Some have raised concern about service quality as the market liberalises. If we believe in consumers' sound judgement and market forces, a voucher scheme should help promote service quality, because the inferior services will lose out. However, we are mindful of the nature of elderly care services and the constraints of this particular group of service recipients. We will therefore work out a quality assurance mechanism under the voucher scheme to complement the market force and safeguard elders' interests.

     A means test is another issue to be carefully addressed. It already exists in conventional community care service. We decided to adapt it for the pilot voucher scheme because we agree with the Elderly Commission that the Government's resources should target the most needy, and that it is only fair for those who have the financial capability to pay more. In the long run, means tests would help ensure that our welfare system is sustainable. We also believe that some service users actually prefer having a choice to co-pay if that would allow them to procure more value-added services. We will work out the implementation details in consultation with the stakeholders. One thing that I can assure you is that no elder will be denied access to the care service they need because of a lack of means.

     We plan to launch the pilot voucher scheme in two phases starting from 2013-14. I would like to take this opportunity to invite NGOs and social enterprises to come forth and join hands with us in this venture. The success of the scheme hinges on your participation, so let us work together to make it a success.  

Conventional subsidised community care services

     Whilst we are planning for a voucher scheme, we will continue to strengthen our conventional subsidised day care and home care services in terms of both quantity, i.e. number of places, and quality. In March this year, we introduced a new home care scheme with improved service content for our frail elders who need nursing care. Some weeks ago, I visited an elderly couple in a public housing estate in Kwun Tong, which is not very far away from the Convention Centre here. The husband, in his early 70s, is already very frail and bedridden most of the time. His wife, also an elder, takes care of him. Our NGO in the district visits this gentleman every other day to provide him with intensive personal care and rehabilitation services, and escort him to see the doctor when necessary. Despite his health condition, the gentleman told me that he much preferred ageing at home. I am glad that his preference is respected.  His case clearly demonstrates that with adequate community care and support, we can fulfill the wish of our elderly and help them age in place.

Interface with health care services

     We are also fully aware of the importance of a smooth interface between health care and long-term care. It is not uncommon for elders to be re-admitted to hospitals or admitted to residential care homes shortly after hospital discharge. Taking the advice of the Elderly Commission, we launched the Integrated Discharge Support Programme for Elderly Patients on a trial basis in 2008. The Programme adopts a multi-disciplinary approach to provide seamless care for elderly hospital dischargees. In each of the participating hospitals, there is a Discharge Planning Team comprising health care professionals and a Home Support Team operated by NGO. The two teams work together to formulate discharge care plans for individual elderly patients. For elders requiring support after hospital discharge, the Home Support Team provides them with a range of community care services. The Programme has demonstrated how comprehensive and continuous care can be provided to elderly patients through better co-ordination of medical and welfare services. It is also instrumental in preventing premature institutionalisation of elders. In view of the satisfactory result of the pilot project, we have decided to extend this Programme to the whole territory.

Support for carers

     Carer support is essential for elders who age in place.  Carers make a big difference to the lives of the elders they care for. Without carers, many elders would need to enter a residential care home. However, taking care of frail elders at home is no easy task. It is even more difficult if the elder you are taking care of has dementia or behavioural problems. As we thank our carers for their patience and devotion, we also need to give them adequate support. In doing so, we are also supporting the elders they care for.

     To equip our carers with the necessary skills in taking care of elders, the Government rolled out the "District-based Scheme on Carer Training" in 2007.  All elderly community centres in Hong Kong can obtain from the Government seed money to run carer training courses in collaboration with community organisations. The courses teach basic elderly care skills, and those who have completed training can be recruited to provide carer services.

     Caring for elders can be rewarding but sometimes it can also be frustrating. Carers need a break from time to time. There are also times when carers need to take care of their own personal matters and they need someone to temporarily take over their carer duties. Our subvented residential care homes and day care centres provide a respite service to elders. But the demand far exceeds supply and it is difficult to get a respite place. To improve the situation, we will make better use of the casual vacancies, in particular those coming from the 137 private residential care homes all over the territory which have joined the Enhanced Bought Place Scheme. This new arrangement will not only increase respite places but will provide a more convenient and accessible respite service for our elders and their carers.

Residential care services

     I have talked a lot about our new initiatives to promote ageing in place. But I must stress that we are by no means reducing our commitment in residential care services. We are fully aware that some elders have to be taken care of in a residential care setting. Although vacancies are available in private residential care homes, we still have a long queue for subsidised ones. We will provide more incentive to improve the quality of the former and continue to increase the supply of the latter.

     While on the subject of quality, perhaps for the benefit of guests from abroad, let me elaborate that residential care homes for the elderly in Hong Kong are subject to a statutory licensing system. We rigorously enforce the legislation but, at the same time, we also encourage residential care homes to participate in independent accreditation schemes to enhance their management and service quality. For consumers, accreditation helps them make informed choices, so it is most welcome. The HKAG, organiser of the conference today, has been a pioneer in accrediting residential care homes. I would like to take this opportunity to pay warm tribute to the HKAG on their contribution in this regard.

Concluding remarks

     There is an old Chinese saying, "Having an elder at home is like having a treasure in the family". How true. Elders are our invaluable asset, certainly not a liability. As our population ages, Hong Kong families will have more treasures. It is our honourable duty to take care of our elderly and ensure that they live with the dignity they deserve. In 2011-12, it is estimated that Government expenditure on the elderly, including social security, elderly care services and healthcare services, amounts to HK$39.6 billion, representing a significant 16.4 per cent of the Government's total recurrent expenditure.

     All of us who are here today are committed to enhancing the well-being of elders. This three-day conference will provide an excellent platform for us to exchange ideas and share experiences. May I wish the Conference every success, and all of you a fruitful discussion. Let us strive to make Hong Kong a community in which to age gracefully. Thank you.

Ends/Thursday, November 24, 2011
Issued at HKT 10:12


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