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ELDERLY SERVICE IN HONG KONG

Elderly Population

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The Hong Kong population is ageing. The proportion of the population aged 65 and over has increased. At the mid of 2008, the population of elderly persons aged above 65 is 12.6% (0.88 million) of the total population in HK. It is estimated that in 2016 and 2033, the percentage will increase to 14% and 27% respectively.
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Our seniors are living much longer than before. In 2005, the population of elderly persons aged 75 or above was around 0.36 million, about 45% of the elderly population. In 2011, the number will increase to 420,000, which is estimated to be 48% of the elderly population. In 2006, life expectancy of male was 79.5 years of age, and the figure for female was 85.6 years of age. In 2033, the figures are expected to increase to 82.7 and 88.3 respectively.
* In 2006, the elderly dependency ratio is 168, i.e. every 1,000 employed persons has to raise 168 elderly persons aged 65 or above. As the elderly population has been increasing and the birth rate is dropping, the figures are expected to increase to 282 in 2023 and 428 in 2033.

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Living Conditions of the Elderly

* According to the statistic profile from the year of 2001 (222,000) to 2006 (279,400), the singleton elderly and older couples who live together has increased 26%. Although most of the elderly persons are still living with their families (around 74.1% of the elderly population), more and more of them are either living alone (11.6%) or living with their spouse only (21.2%).
* Most of the elderly persons aged 60 have retired, and only around 12% are still working in mid 2008. According to a survey conducted in 2006, median earnings of elderly persons was HK$6,500 per month (median earnings per head in Hong Kong was HK$10,000), and over 80% of the elderly persons were living on savings. In 2008, over 0.18 million elderly persons aged 60 or above are receiving social security allowance (17% of the elderly population). In addition, around 483,000 elderly persons aged 65 or above are receiving old age allowance (55% of elderly persons aged above 65).
* Nonetheless, those soon-to-be-old (aged 45-59 years old) people are more educated and are financially more viable. Over 50% of them have secondary school education or above, whereas 78.7% of those aged over 60 are having primary school education or below. Besides, one-third of them are having different kinds of retirement protection, compared to around 16% of those aged over 60.

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Health Conditions

* Most elderly persons are still healthy with over 70% of them are suffering from one kind of or more chronic illnesses. Among them, the most common illnesses include hypertension, arthritis, ophthalmology problems, and diabetes.
* In 2006, there are about 70000 elderly persons suffering from Dementia who are living in the community. It is projected that the numbers of demented persons will significantly increase to 0.33 million by the year of 2050. Among those who are aged 75 or above, about 22% are suffering from cognitive difficulties.

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Elderly Service in Hong Kong

Since November 2000, the Social Welfare Department has implemented the Standardised Care Need Assessment Mechanism for Elderly Services. Under the Mechanism, an internationally recognised assessment tool, Minimum Data Set-Home Care (MDS-HC) is adopted to ascertain the care needs of elders and match them with appropriate services. With the implementation of the Central Waiting List for subsidised long term care services, the Mechanism has since 28 November 2003 been extended to cover eligibility screening for applications for long term care services.

The Mechanism covers applications for admission to homes for the aged, care-and-attention homes, nursing homes, day care centres for the elderly, enhanced home and community care services, and integrated home care services (for disabled and frail cases). Assessors under the Mechanism are professionals from various disciplines such as social workers, nurses, occupational therapists and physiotherapists. They are required to go through training and accreditation on the use of the assessment tool. As at 31 Mar, 2009, we have 2167 accredited assessors.
* Community Support Services
 

The service objective is to assist elderly persons to remain living in the community for as long as possible. These services also give support to carers. With increasing diversity of community support services for the elderly, a more integrated approach to facilitate access to services will be adopted.
   
Service Types
Services Provided
Subvented Units
Neighborhood Elderly Centre NEC is a type of community support services at neighbourhood level which provides a range of comprehensive services to cater for the psycho-social and developmental needs of both healthy and mildly frail elders, including, educational and developmental activities, volunteer development, carer support service, counseling service, reaching out and networking, social and recreation activities, meal service, drop-in service, Information and referral centre on community resources.
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Social Centre for the Elderly
Social Centres for the Elderly organize social and recreational activities for elders in the community and to provide information regarding welfare services for the elders and referral to appropriate services.

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District Elderly Community Centre
DECC is a type of community support services at district level to enable elders to remain in the community, to lead a healthy, respectful and dignified life, to enhance their positive and contributing role and to involve the public to build up a caring community. DECC provides services including community education, case management, support team for the elderly, health education, educational and developmental activities, information and referral centre on community resources, volunteer development, carer support services, social and recreational activities meal and laundry services, drop-in service.
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Support Team for the Elderly
To reach out to single and needy elderly and provide them with social networking and support service; encourage volunteers to visit and assist single elderly.
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Day Care Centre for the Elderly
Day Care Centres for the Elderly provide a range of centre-based care and support services during daytime to enable the frail and demented elders suffering from moderate or severe level of impairment to maintain their optimal level of functioning, develop their potential, improve their quality of life and to enable them to live in their own homes wherever feasible and possible. Services provided by Day Care Centre includes nursing care, rehabilitation training, health education, carer support services, day respite service, counselling and referral services, social and recreational activities, meal, transportation service.

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(2,234 service quota* 08-09 revised estimate)
Integrated Home Care Service Team

Integrated home care services aims at providing difference kinds of care and services to the elders, the disabled, individuals and families with social need.

Services for frail cases
The Integrated Home Care Services Teams (IHCSTs) should address individual service users' health concerns and corresponding needs by applying a multi-disciplinary approach including nursing care, personal care, rehabilitative service and social work service etc. A planned and well co-ordinated package of home care and community care service tailor-made for individual service user according to their frailty and disability.

Services for ordinary cases including Personal care / simple nursing care service, general household or domestic duties, escort service Child-minding, home respite service health/safety, purchase and delivery of daily necessities, provision of meals and laundry service.

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(28,600 service quota*, 08-09 revised estimate)
Enhanced Home and Community Care Services
To provide enhanced day and community care services to frail people suffered from moderate level of impairment, meet their nursing and care needs and provide support to their carers. The services including care management, basic and special nursing care, personal care, rehabilitation exercises, centre-based day services, carer support services, respite service, out-of-hour emergency support, environmental risk assessment and home modifications, home-making service, provision of meals, transportation and escort service.

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(3,700 service quota* 08-09 revised estimate)
Holiday Centre for the Elderly

To provide holiday facilities in the countryside for elderly people (including those who need care-and-attention service) to take a rest and to enjoy pastime with their families and friends.
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* Residential Care Services
  The service objectives are to provide residential care and facilities for those who, for health, social and other reasons, are unable to live at home, and provide assistance in their daily living according to their varying personal care needs.
   
Service Types
Services Provided
Capacities as at 31 March 2009
Hostel for the Elderly
(will be gradually phased out and converted to higher level of care)
To provide communal living accommodation, various programmes and care to elderly persons who are capable of self-care, and yet require support and guidance in daily living activities.

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  • subvented: 24
  • self-financing: 15


Home for the Aged
(will be gradually phased out and converted to higher level of care)
To provide residential care, meals, laundry service, a limited degree of assistance in activities of daily living, and social activities for elderly persons who are unable to live independently in the community. However, they are not dependent on assistance with personal or nursing care.

1,891

  • subvented: 672
  • self-financing: 1,219
Care-and-attention Home
To provide residential care, meals, personal care and limited nursing care for the elders who suffer from poor health or physical/mild mental disabilities with deficiency in activities of daily living.

23,640

  • subvented: 14,375
  • self-financing: 2,644
  • bought place and enhanced bought place: 6,621

 
Nursing Home
To provide residential care, personal care, medical and nursing care to the elders who, as a result of deterioration in their health condition, cannot be adequately cared for in care-and-attention homes.

2,986

  • subvented: 2,086
  • self-financing: 900
Residential Respite Service
To provide temporary or short-term residential care service for the elders. It serves the objectives of providing temporary relief to family members or relatives who are the main carers of elders requiring a certain degree of personal care whilst resident in normal environment within the community.
11 places at 11 homes, and casual temporary vacant places at residential homes
Emergency Placement Service
To provide a temporary shelter for the elders in urgent need of accommodation and care.
65 places at 24 homes

 

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Future Trends

* Meet with the different needs of the future cohort
 

The new cohort of seniors, being more educated and financially viable, is expected to have different needs than the current cohort. They would be more active in voicing out their needs and have different demands on the service contents, models and qualities. If the future policy requires them to pay more according to their affordability, their expectations would be even higher.
* Establish Long-term Care System
 

As the number of frail elderly has been increasing, different government departments, including those concerning health care, medical and welfare services, should work more closely in providing multi-disciplinary services, and establish a seamless long-term care system. At present, we will keep on advocating for more community support services, as well as helping carers to care for their elderly members at home. Residential services will be provided to frail elderly and those who cannot be adequately cared for by their families.
* Studying the Long-term Care financing arrangement
 

The aged population is going to reach its peak in the coming decade when the baby-boomers begin to enter into their old age. Coupled with the low fertility rate, sustainability of the current Long-term Care financing arrangement will become a critical concern.
* Increase in service varieties
  Services for the seniors will become more and more diverse. Some are in response to the change in policy and some are in response to the changing needs of the seniors. One of the examples is the transfer of infirmary service from hospitals to welfare sector. Another is the assisted living housing. This kind of retirement housing integrates conventional housing and care under one roof.
* Service Integration
 

In future, the development of services for the elderly will adopt the concepts of continuum of care and service integration. The services will be refocused to provide the elders with one-stop and professional services, so that they can obtain services at home or in home-like environment. Programmes include Pilot Project on Continuum of Care at residential care homes, Enhanced Home and Community Care Services, and all kinds of integrated community support services for the elders, etc.
* Multi-skills Training
 

As integration becomes the major trend in elderly service, welfare personnel are required to learn and master different skills and knowledge necessary to provide quality care to the elders, such as nursing care, psychological and social care of the elders, etc.

International Linkages

* International Federation on Ageing
* International Association of Gerontology
* HelpAge International

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(June 2009)

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