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LCQ10: Subsidised residential care places for the elderly

     Following is a question by Dr Hon Joseph Lee Kok-long and a written reply by the Secretary for Labour and Welfare, Mr Matthew Cheung Kin-chung, in the Legislative Council today (June 6):


     At present, elderly people with long-term care service needs wishing to stay in subsidised places in residential care homes for the elderly (RCHEs) have to wait for quite a long time.  They may stay in private RCHEs at their own costs before they are allocated subsidised places.  If their children cannot afford private RCHE places, such elderly people may apply for the Comprehensive Social Security Assistance (CSSA) to pay for the relevant fees, but their children are required to make a declaration of not covering living expenses for them (commonly known as "declaration of not providing support to parents" or "bad son statement") before the elderly people can receive CSSA payments.  It has been learnt that due to traditional values, inadequacy of CSSA payments and lack of monitoring on private RCHEs, quite a number of elderly people have not received proper RCHE services.  In this connection, will the Government inform this Council:

(a) whether the authorities have considered revising the requirement concerning the "bad son statement" to allow elderly people who receive limited support from their children to apply for CSSA, thereby enabling them to have sufficient resources to choose RCHEs that suit them; if they have, of the details; if not, the reasons for that;

(b) whether the authorities have considered introducing other measures (including joint subsidies approach), with the aim of reducing the Government's financial burden on the one hand and dispensing with the requirement for the children to sign "bad son statements" on the other, so as to enable more elderly people in need to be expeditiously admitted to RCHEs to receive proper residential care; if they have, of the details; if not, the reasons for that;

(c) given that the Government proposed a Fee Assistance Scheme (FAS) for residential care services in 2003 to directly subsidise eligible elderly people who have care and financial needs, in the form of a "voucher", to enable them to receive residential care services at RCHEs of their own choice, of the progress of FAS; and

(d) given that some elderly people have indicated that as private RCHEs are of varying quality and the fees are expensive, most of the elderly people do not want to live in private RCHEs, whether the Government has any plan to step up regulation of private RCHEs, with a view to boosting the confidence of elderly people in private RCHEs and alleviating the waitlisting situation for subsidised places; if it has, of the details; if not, the reasons for that?



     My reply to Dr Hon Joseph Lee Kok-long's question is as follows:

(a) and (b) The Comprehensive Social Security Assistance (CSSA) Scheme aims to help families in financial hardship meet their basic needs.  CSSA payments can be flexibly deployed and used for meeting elderly residential care expenses of the recipients if necessary.

     CSSA applicants are subject to means test.  This is because CSSA is basically an income supplement.  The Administration will first ascertain the recognised needs of the applicant and then verify his deployable resources.  The shortfall would be met by CSSA.  For applicants who have the financial support of family members and therefore need not rely solely on CSSA, they should so declare.  This helps ensure the proper use of public money and enable the non-contributory CSSA Scheme to operate in a sustainable manner.  The above principle applies to all applicants, including elders.  As such, when elders apply for CSSA on their own, we require their children to make a simple declaration.  The purpose of the declaration is not to prove that they do not contribute to the living expenses of their parents, but for them to provide factual information on the financial support they give.  There is a practical need for this arrangement.  Otherwise, it would be difficult for the Administration to ascertain the financial situation of the applicant and calculate the amount of CSSA that he may receive.  

     Noting that many elderly CSSA recipients choose to live in non-subsidised residential care homes for the elderly (RCHEs), we have, since June 1, 2012, introduced a new Residential Care Supplement of $265 per month for all CSSA recipients aged 60 or above who occupy non-subsidised residential care places for the elderly, so as to ease their financial burden.  There are about 25 000 elderly recipients in total benefiting from this at present.

(c) The Elderly Commission (EC) had examined in detail the viability and impact of implementing a "residential care voucher" in Hong Kong when it deliberated on the Consultancy Study Report on Residential Care Services for the Elderly (Consultancy Study) in 2009.  

     The Consultancy Study pointed out that promoting "ageing in place" was a global trend.  While there were many overseas examples of using "cash voucher" to provide community care services (CCS) for the elderly, there were very few cases of using "cash voucher" to subsidise elders' residence in RCHEs.  Besides, having regard to the fact that the institutionalisation rate of elders in Hong Kong was on the high side, and that cash voucher would probably prompt more people to opt for residential care services (RCS) prematurely or when they had no such need, the Consultant had reservation about introducing "residential care voucher" at this stage, and recommended that the Government should promote a balanced development of CCS and RCS first.  

     EC generally agreed with the Consultant.  It opined that before implementing any form of "cash voucher", we should ensure that the market have available different kinds of elderly care services that suit elders' needs, enabling them to make the most suitable choices, and thereby allowing those with genuine needs for RCS to be allocated residential care place more quickly.

     To this end, the Government is planning for a pilot scheme on CCS voucher for the elderly to try using this new funding mode to further promote the development of CCS.

(d) At present, there is a licensing system to regulate RCHEs under the Residential Care Homes (Elderly Persons) Ordinance (Cap. 459) (the Ordinance).  The Director of Social Welfare has also issued a Code of Practice for Residential Care Homes (Elderly Persons) under section 22(1) of the Ordinance to ensure that the premises, design, staffing, operation, management, etc of licensed RCHEs comply with the licensing requirements, and that RCHEs have the necessary resources to attend to the care needs of their residents and to provide a safe and hygienic living environment for them.  

     The Licensing Office of Residential Care Homes for the Elderly (LORCHE) of SWD inspects RCHEs pursuant to section 18 of the Ordinance. At present, LORCHE conducts, on average, seven surprise inspections to each private RCHE per year.  The frequency of inspections would be adjusted based on the past service performance and risk level of individual RCHEs.

     The Social Welfare Department (SWD) has been implementing various measures to encourage RCHEs to enhance their service quality.  For instance, private RCHEs which can enhance their services (including staffing and spatial standards) to the specified standard can participate in the Enhanced Bought Place Scheme (EBPS) and offer their places for purchase by the Government.  Since the entire RCHE has to comply with the specified service standard before joining EBPS, users of non-bought places in the RCHE could also benefit.  We also encourage those RCHEs which are providing EA2 places under EBPS to raise their service quality to the higher EA1 standard.  To this end, the Government has earmarked funding in 2012-13 to purchase about 600 places which have been upgraded from EA2 to EA1 level.

     In addition, SWD has been implementing the Pilot Scheme on Visiting Pharmacist Services for RCHEs since 2010 to enhance the drug management capabilities of RCHEs and their staff.  SWD also promulgates guidelines for RCHEs on various topics related to the management of RCHEs and elderly care; provides training for RCHEs staff on a regular basis to enhance their knowledge and skills in elderly care; and works closely with the Department of Health and Hospital Authority in devising service guidelines and making case referrals.  All these measures help enhance the quality of RCHEs.

Ends/Wednesday, June 6, 2012
Issued at HKT 13:30


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