Hong Kong Christian Service

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Issue 008
2015 July

From the elderly abuse case in Tai Po Cambridge Nursing Home Limited to Residential Care Service Vouchers Pilot Scheme

The elderly abuse cases in Cambridge private home uncovered the uneven qualities and lack of monitoring. This causes many to raise skepticism towards the hasty implementation of Residential Care Vouchers Pilot Scheme (Residential Vouchers Scheme) without thorough consideration of the direction of elderly policy. Is such policy really offering elderly a choice? What is more puzzling is that if the government really implements the Scheme as recommended by the consultants and allocate $0.8 billion, would that be a mismatch of resources?

Against the direction of "ageing in place"

It is generally agreed that "ageing in place" is the direction of the elderly policy in order that the elderly could continue to live in a familiar community and being taken care of by their family members. This could reduce premature or undue residential places demands. It has been proven that staying at home or making use of community care can effectively reduce the need on residential service especially for those who choose to live with their families. Nevertheless, the present situation is that community care service is in acute shortage and the government did not put enough resources to achieve the goal of ageing in place.

According to the 2014 Hong Kong Council of Social Service findings about waiting list for integrated home care (normal cases), it takes an average of 7 months for meal delivery service, 15 months for escort service, 21 months for household cleaning. Even though they have successfully been admitted to the service, household cleaning can only be provided one hour per month, escort service once every 3 months. The waiting list is extremely long and it has never been improved in terms of resources or needs.

Even though the community care quota has an increase of 35% from 7,010 in 2009 to 9,450 in 2014, but the queuing time for community care has gone up 84%, from 2,330 cases to 4,280 which means the increase of quota cannot meet the service demands. In 2014, the average waiting time for day care and home care service are 8.5 months and 5.3 months respectively, and it is more than a year for some of the areas in the new territories.

Both the elderly and their family members are apprehensive while queuing for service, the elderly would degenerate rapidly without the required support, they may need to go to care and attention home by the time they finally have their turn. This is actually against the ‘age in place’ policy.

Precaution: giving our elderly a real choice

According to Audit Commission of HKSAR, government expenditure in 2013-14 on community care is about $0.97 billion. When compare to the $0.8 billion on Residential Vouchers Scheme, the expenditure on community care for a year will be more than 80%! The government should be cautious whether that $0.8 billion is to be spent on the Residential Voucher Scheme or on the long-standing shortage of Community Care Service.

In fact if we could prevent elderly degeneration at its early stage, it could greatly reduce the demand for residential service. Due to limitation of resources, normal cases cannot enter the long term care system. Elders with mild grade impairment such as mild grade dementia, bodily deficiency but could still walk etc could not get the rehabilitation support from the community and miss the best time for support.

If the government could use that $0.8 billion to review home care and community care service, to assist the frail elders to age in place, to design a comprehensive, integrated, abundant community care service, to provide wide-ranging support or even subsidies for their carers, fine tune the existing elderly community care service vouchers scheme etc, these are what we meant by giving them a choice. The core issue is that the government should have a clear, precise and a long term planning in Elderly policy, these include improvement of the existing bought place scheme, improve the manpower and space ratio in both government subsidised and private homes, to improve the monitoring system on private home, setting up an effective case management system and its related support, review payment of private homes by CSSA etc. All these cater to a comprehensive care to the elderly in all aspects.

Extended reading:
Legco paper CB(2)820/14-15(01): Feasibility Study on Residential Care Service Vouchers Pilot Scheme by Department of Social Work and Social Administration, University of Hong Kong

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