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LCQ12: Care services for the elderly
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     Following is a question by the 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 (April 24):

Question:

     Regarding the care services for the elderly, will the Government inform this Council:

(a) of the progress of the authorities' follow-up actions on the following three recommendations put forward in the Elderly Commission's report on the Consultancy Study on Residential Care Services for the Elderly: (i) devising a viable and sustainable long-term care financing model, (ii) re-considering the service matching mechanism (including the service arrangements for the elderly who are suitable for the "dual option" of either residential or community care services), and (iii) further development of community care services;

(b) of the details of the services currently provided by the hospitals participating in the Integrated Discharge Support Programme for Elderly Patients (IDSP) and by the Home Support Teams under non-governmental organisations (including the number of such support teams, the numbers of the elderly and carers benefitting from IDSP, as well as the average waiting time of IDSP); whether the authorities have set separate targets on the numbers of cases to be handled by the 15 participating hospitals of IDSP; of the difference in the frequency of utilising hospital services by the elderly before and after their participation in IDSP; of the difference in the stress level of the carers before and after their participation in IDSP; of the criteria and approach adopted by the authorities for assessing the effectiveness of IDSP;

(c) given that the five-year Home Environment Improvement Scheme for the Elderly had been concluded in March this year, of the respective numbers of the elderly who had applied for and those who had benefitted from the Scheme in each of the past five years, broken down by Social Welfare Department district; whether the authorities will launch this Scheme again; if they will, of the details; if not, the reasons for that; and

(d) of the respective numbers of subsidised places for home-based Enhanced Home and Community Care Service and Integrated Home Care Services provided by the Government to the frail elderly in each of the past five years (broken down by type of services); whether the Government will increase the numbers of subsidised places for such services in the coming five years; if it will, of the details; if not, the reasons for that?

Reply:

President,

     My reply to the question raised by the Hon Cheung Kwok-che is as follows:

(a) The Elderly Commission completed the Consultancy Study on Residential Care Services (RCS) for the Elderly in 2009, and launched the Consultancy Study on Community Care Services (CCS) for the Elderly in April 2010 to examine how to strengthen CCS through a more flexible and diverse mode of service delivery and encourage shared responsibilities among individuals, families and society. Following the release of the findings of the Consultancy Study on CCS for the Elderly in July 2011, the Government has adopted the Consultancy Study's recommendation on CCS voucher, and will roll out the Pilot Scheme on CCS Voucher for the Elderly (the Pilot Scheme) in September 2013. The Pilot Scheme will adopt the "money-follows-the-user" approach, and provide subsidy directly to eligible elderly participants, enabling them to choose the service provider(s), service types and packages which best suit their needs. Through the Pilot Scheme, we hope to test the viability of voucher, which is a new funding mode, and attract different types of service providers to enter the market, thereby promoting further development of CCS. Our next step is to review the implementation of the Pilot Scheme and gather feedback from the elderly participants, and explore the feasibility of adopting this voucher subsidy mode for RCS for the elderly.

     The Consultancy Study on RCS for the Elderly also recommended adjustments to the existing service matching mechanism, such that "dual option" holders (i.e. those who can opt for RCS or CCS) would be encouraged, or even required, to use CCS before choosing RCS in order to promote "ageing in place" and also shorten the waiting time for residential care places for the elderly. Nevertheless, considering that CCS was still under development, and that the private/self-financing market for providing such services was far from mature, the consultant considered that the recommendation should not be taken forward until CCS would be enhanced to such an extent that it had become a viable alternative to RCS. We concur with this view. In fact, one of the objectives of the above Pilot Scheme is to promote the development of CCS. At present, to dovetail with the "ageing in place" policy, irrespective of whether the elderly persons are matched to both RCS and CCS, or RCS only according to the assessment results of the Standardised Care Need Assessment Mechanism for Elderly Services, the case workers concerned will brief the elderly persons on both RCS and CCS and encourage them to use CCS so that the elderly persons can get support as early as possible and achieve ageing in place. The Social Welfare Department (SWD) will from time to time review and refine the relevant mechanism as well as collect views from the sector.

(b) The hospitals currently participating in the Integrated Discharge Support Programme for Elderly Patients (IDSP) and the 12 Home Support Teams (HSTs) operated by nine non-governmental organisations (NGOs) commissioned by the Hospital Authority (HA) are set out in table 1.

     IDSP provides services to high-risk elderly patients aged 60 or above who are admitted to hospitals under HA. These elderly patients usually suffer from more complicated conditions. There is thus a high risk of unplanned re-admission. They also need more support after discharge. In the early stage of patients' hospitalisation, the Discharge Planning Team of the hospitals will identify high-risk patients by using a validated risk-stratification tool. Nurses will then proactively conduct comprehensive needs assessment for the high-risk patients, and formulate a personalised nursing care and rehabilitation plan for them accordingly. Nurses will also co-ordinate support services on a need basis. For example, patients who have rehabilitation needs will be referred to geriatric day hospitals for nursing care and rehabilitation services. As regards HSTs, they will provide transitional community care and support services to the elderly persons in need of personal and home care services. It is estimated that IDSP provides services to about 33 000 elderly persons each year. At present, the patients can use IDSP services directly without the need to wait.  

     HA evaluated the effectiveness of IDSP based on the data collected during its trial run in 2009. The results showed that there was a remarkable drop in the number of times the elderly persons participating in IDSP used the accident and emergency services, and the acute inpatient services of hospitals. There were also improvements in the measuring indicators on their functional capacity, ability in performing daily self-care activities, and quality of life, such as the Barthel Index and the SF12: Physical Component and Mental Component Summary Scale. HA also used the Relative Stress Scale to measure changes in the carers' stress level. It was found that carers' stress level had also significantly reduced. Since the aforementioned statistics all fully reflected the effectiveness of IDSP, the services were regularised in January 2012 and implemented across the territory. At present, HA has continuously collected carers' opinions on HSTs through a questionnaire survey. The relevant statistics showed that carers were highly satisfied with HSTs services and training.  

(c) The Government earmarked a one-off funding of $200 million in the 2008-09 Budget to implement the "Home Environment Improvement Scheme for the Elderly" (the Scheme) for five years to assist elderly persons who live in dilapidated homes with poor fittings and lack financial means to improve their home conditions. A total of 41 District Elderly Community Centres throughout the territory assisted in running the Scheme. The number of applications received and the number of eligible applications by each district and year since the implementation of the Scheme are set out at Annex I and II.

     While the Scheme ended successfully on March 31, 2013, needy elderly can still receive assistance through various channels. Some local organisations and charitable funds also provide home maintenance services, or purchase essential household items for needy elderly and families.

(d) The number of service places of the Enhanced Home and Community Care Services (EHCCS) and the Integrated Home Care Services (IHCS) for frail elderly persons in the past five years (i.e. from 2008-09 to 2012-13) are set out in table 2.

     In addition to EHCCS and IHCS (Frail Cases), the Administration also provides other types of CCS to help frail elderly persons age in the community. These services include day care services for the elderly, the Pilot Scheme on Home Care Services for Frail Elders, as well as the Pilot Scheme on CCS Voucher for the Elderly which will be rolled out in September 2013, etc. We expect that 182 new day care places for the elderly will commence operation in 2013-14. SWD will continue to attend to and follow up on the needs of the elderly persons.

Ends/Wednesday, April 24, 2013
Issued at HKT 20:20

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