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LCQ10: Elderly care services
     Following is a question by the Hon Alvin Yeung and a written reply by the Secretary for Labour and Welfare, Mr Stephen Sui, in the Legislative Council today (April 12):
     Regarding services for the elderly, will the Government inform this Council:
(1) of the respective numbers of community care services places provided by the Government for elderly persons with mild and moderate impairment and the expenditures involved, in each of the financial years from 2012-2013 to 2016-2017;
(2) whether it knows the number of community nurses in each hospital cluster and the ratio of that number to the elderly population in the catchment area of the cluster, as at December 31 of last year;
(3) whether it knows (i) the number of palliative care beds (with a breakdown of occupancy rate by age of users) and (ii) the number of registered medical practitioners specialised in palliative medicine, in each hospital cluster in each of the past five years;
(4) whether it knows the number of elderly persons who passed away after being transferred from residential care homes to public hospitals for treatment, and the average number of their inpatient bed days before they passed away, in each of the past five years; and
(5) of the details of the palliative care services provided in each of the past five years by the Government in support of the passing away of the elderly persons at home or at residential care homes?
     Elderly care is at the top of the current-term Government's agenda. The Government has all along been strengthening elderly care services based on the principle of "ageing in place as the core, institutional care as back-up" and putting resources in this area. From 2012-13 to 2017-18, the Government's recurrent welfare expenditure on elderly services (excluding financial assistance under social security) has increased from around $5 billion to around $7.8 billion, marking an increase by over 55 per cent.
     In consultation with the Food and Health Bureau, my reply to various parts of the question raised by Hon Alvin Yeung is as follows:
(1) To achieve the objective of "ageing in place", the Social Welfare Department (SWD) provides a series of centre-based and home-based subsidised community care services (CCS), including home-based Enhanced Home and Community Care Services, Integrated Home Care Services (Frail Cases) and centre-based Day Care Centres/Units for the Elderly. All of the targeted users of these services are elderly persons assessed to be of moderate or severe level of impairment by the Standardised Care Need Assessment Mechanism for Elderly Services (SCNAMES). As for Integrated Home Care Services (Ordinary Cases), elderly persons who use the service are not required to undergo the standardised assessment under SCNAMES. The number of places and expenditure of various subsidised CCS for elderly persons from 2012-13 to 2016-17 are set out in Annex 1.
(2) The number of Community Nurses (CN) in each hospital cluster of the Hospital Authority (HA) and their ratio to local elderly persons in 2016-17 (as at December 31, 2016) are set out in Annex 2.
(3) With the aim to provide holistic care for patients, HA has been providing palliative care services with a comprehensive service model for terminally ill patients and their families through a multi-disciplinary team of professionals, including doctors, nurses, medical social workers, clinical psychologists, physiotherapists and occupational therapists, etc.
     As at December 31, 2016, HA has over 360 palliative care beds. Besides, some terminally ill patients admitted to other specialties and in need of palliative care services can also receive treatment from the palliative care teams. Statistics on the utilisation of palliative care inpatient service from 2012-13 to 2016-17 are set out in Annex 3.
     At present, palliative care services in HA are mainly provided by healthcare personnel of the Palliative Care Units and Oncology Centres. Since the Oncology Centres are subsumed under the overall establishment of the Oncology Departments, separate statistics on the number of doctors working specifically for the provision of palliative care services are not readily available.
(4) and (5) The Government, through the social workers of Integrated Family Service Centres, Integrated Service Centres, District Elderly Community Centres, Neighbourhood Elderly Centres or Medical Social Services Units stationed in hospitals, etc. under SWD or subvented non-governmental organisations (NGOs), has all along been providing a variety of support services for elderly persons and their family members, which include counselling, referral, emotional support, crisis intervention and financial assistance, etc. Moreover, the Government supports NGOs to organise end-of-life support services for elderly persons and their family members through various charitable trust funds. Such services include encouraging elderly persons to plan ahead their end-of-life plan, providing care and support for elderly persons and their family members near end of life and free funeral services, etc.
     Under the Lump Sum Grant Subvention System, operators of subvented residential care homes for the elderly (RCHEs) have the flexibility to deploy the subventions and arrange suitable staffing to provide end-of-life care services in their RCHEs. Starting from 2015-16, all new contract RCHEs and existing contract RCHEs under new contracts provide end-of-life care services for elderly residents and their carers. By utilising the additional resources provided by SWD, contract RCHEs adopt a co-ordinated and multi-disciplinary approach to render professional and systematic holistic care to elderly residents suffering from life-threatening or chronic illnesses and approaching the end of life, as well as support to carers. The services aim at alleviating the pain and discomfort of the elderly residents, relieving the stress of elderly persons and the carers, as well as helping elderly persons face death in a dignified and peaceful manner. The scope of care includes medical and nursing care, psychological and bereavement care, social and family support, spiritual care and death preparation.
     Currently, palliative care services are provided by HA in all seven clusters to support terminally ill patients and their families. HA's palliative care services include inpatient service, outpatient service, day care service, home care service, bereavement counselling, etc. Statistics on the utilisation of these services, except palliative care inpatient service, from 2012-13 to 2016-17 are set out in Annex 4.
     Since 2015-16, HA has been strengthening services of the Community Geriatric Assessment Team (CGAT) service in phases for terminally ill elderly residents living in RCHEs. CGATs work in partnership with RCHEs and the palliative care teams to provide training for RCHE staff and improve the quality of medical and nursing care of RCHEs. CGATs currently cover about 650 RCHEs. SWD and HA do not capture statistics on the number of elderly persons living in RCHEs who pass away after transfer to public hospitals for treatment or their duration staying in the hospital before passing away. 
Ends/Wednesday, April 12, 2017
Issued at HKT 15:05
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