Legislative Council

LC Paper No. CB(2) 1006/98-99

Ref : CB2/PL/WS

LegCo Panel on Welfare Services

Minutes of meeting
held on Monday, 19 October 1998 at 10:45 am
in Conference Room A of the Legislative Council Building

Members Present:

Hon CHAN Yuen-han (Chairman)
Hon HO Sai-chu, JP (Deputy Chairman)
Hon David CHU Yu-lin
Hon Cyd HO Sau-lan
Hon LEE Cheuk-yan
Hon Fred LI Wah-ming
Hon YEUNG Yiu-chung
Hon LAW Chi-kwong, JP

Members Absent :

Hon Eric LI Ka-cheung, JP
Hon LEE Kai-ming, JP
Hon Ronald ARCULLI, JP
Dr Hon YEUNG Sum
Hon CHOY So-yuk

Member Attending :

Hon Michael HO Mun-ka

Public Officers Attending :

Item III - Rehabilitation and support services for ex-mental patients

Mr Robin GILL

Deputy Secretary for Health and Welfare (3)

Mrs Patricia CHU

Deputy Director of Social Welfare (Services)

Mr Augustine CHOI

Commissioner for Rehabilitation

Miss Ophelia CHAN

Assistant Director of Social Welfare

(Rehabilitation and Medical Social Services)

Mr FUNG Man-lok

Senior Social Work Officer (Medical Social Services)

Mr SIU Lap-kei

Senior Labour Officer (Selective Placement) Labour Department

Dr CHOY Khai-meng

Executive Manager(Professional Services) 1

Hospital Authority

Dr YIP Ka-chee

Chief of Service (Psychiatry)

Kowloon Hospital

Item IV - Consultancy Study on needs of elderly in Hong Kong for community support and residential care services - meeting with deputations

Mr HO Wing-him

Deputy Secretary for Health and Welfare (2)

Mrs Patricia CHU

Deputy Director of Social Welfare (Services)

Mr C H LO

Principal Assistant Secretary for Health and Welfare (Welfare 1)

Miss Monica CHEN

Principal Assistant Secretary for Health and Welfare (Elderly Services 1)

Mrs Eliza LEUNG

Assistant Director of Social Welfare (Elderly)

Attendance by Invitation :

Association for the Rights of the Elderly

Ms Rita LAM Yu-kiu

Chairperson

Mr Benson NG Yuk-ming

Representative

Hong Kong Council of Social Service

Mr LEE Kar-mut, Division Officer

Services for the Elderly Division

Ms Anita WONG, Chairperson

Committee on Residential Services

for the Elderly Services for the Elderly Division

Mrs LAW LEUNG Wai-yuen, Chairperson

Committee on Home Help Service

Family Service and Child Care Division

Hong Kong Young Women's Christian Association

Chi Po Social Centre for the Elderly

Ms LEE Fung-chun

Hong Kong Psychogeriatric Association

Dr LI Siu-wah

Vice President

Clerk in Attendance :

Ms Doris CHAN

Chief Assistant Secretary (2) 4

Staff in Attendance :

Mrs Eleanor CHOW

Senior Assistant Secretary (2) 4

I.Confirmation of the minutes of meeting held on 14 September 1998 and matters arising

(LC Paper No. CB(2)439/98-99)

1. The minutes of the meeting held on 14 September 1998 were confirmed without amendment.

II.Date of next meeting and items for discussion

(LC Paper No. CB(2) 417/98-99(12))

2. Members agreed to discuss the following items at the next meeting to be held on 9 November 1998 at 10:45 am -

1. Services for young people; and

2. Social Welfare Services Development Fund.

3. Mr LAW Chi-kwong suggested and members agreed to review the rapid expansion of the Social Welfare Department (SWD) and its role in the provision of direct social services at the meeting to be held in December 1998.

III.Rehabilitation and support services for ex-mental patients

(LC Papers Nos. CB(2) 357/98-99(01), 411/98-99(01) and 450/98-99(01))

4. Mr LAW Chi-kwong, who proposed the item for discussion, said that a motion was carried by the former Legislative Council on 30 April 1997 urging the Government to allocate more resources, improve the process of service delivery and strengthening the interface of the services for mental patients, so as to provide them with sustained and comprehensive treatment, aftercare and rehabilitation services and to help them re-integrate into the community. He pointed out that although the government had made some improvements, many problems remained unsolved. To address the problems, the Democratic Party had set out its recommendations on service improvement in LC Paper No. CB(2) 357/98-99(01).

5. At the invitation of the Chairman, Deputy Secretary for Health and Welfare (3) (DSHW(3)) briefly introduced LC Paper No. CB(2) 411/98-99(01). He said that the ultimate objective of the different types of services outlined in the paper was to facilitate discharged mental patients to re-integrate into the community. The services were provided through the collaborated efforts of the Government, the Hospital Authority (HA) and non-governmental organizations (NGOs). As public education on mental health played an important part in the social rehabilitation of mental patients, the government had stepped up mental health education to promote a better understanding and acceptance of mental patients and discharged mental patients by the community.

6. Commissioner for Rehabilitation (CR) supplemented that in the past five years, the Government had launched a number of public education activities including the "Mental Health Month". It was hoped that with the public acquiring better understanding of mental illness, discharged mental patients could be more readily accepted by the community and the relapse of discharged mental patients could be prevented or detected at an early stage. He said that a recent TV drama series with a role played by an incumbent patient had received favourable response from the public.

Half-way houses

7. Mr LAW Chi-kwong said that although the Government had provided six additional aftercare workers to help former residents of half-way houses in the past year, many discharged mental patients were still not able to receive sufficient aftercare service. CR responded that with the six additional aftercare workers in 1998-99, there were now a total of eight social workers. He considered that the present provision was adequate to meet the existing and projected demand, given that existing caseload indicated that seven aftercare workers would suffice.

8. CR further said that as at October 1998, there were 31 halfway houses providing 1 177 places and some 500 patients on the waiting list. As some patients had preference for certain locations, some halfway houses still had places available while others were fully occupied and might have a long waiting list. The Government had provided 320 additional halfway house places in the past three years and resources had already been allocated to provide 200 additional halfway house places in the next few years.

9. Mr LEE Cheuk-yan enquired about the waiting time for halfway houses for different groups of discharged mental patients and the timetable for providing 200 additional places in the next few years. Assistant Director of Social Welfare (ADSW) explained that special provision in halfway houses was available to discharged mental patients with a record of criminal violence or who were assessed to be disposed towards violence (i.e. sub-target group). Out of the 1 177 halfway house places, 110 places were specifically allocated to the sub-target group and they were not fully taken up at present. As for other discharged mental patients, the average waiting time for halfway homes for those who had no preference of location was about one month. The halfway house in Aberdeen had places immediately available while the popular halfway house in Shatin could not meet demand. The waiting time for halfway house places ranged from one month to six months depending on the location. The timetable for the 200 additional places was as follows: 40 in 1999-2000, 40 in 2000-2001, 80 in 2001-2002 and 40 in 2002-2003.

10. Mr LEE Cheuk-yan pointed out that the long waiting time was a result of mismatching of location of halfway houses. As regards the remedial measures to be taken by the Administration, ADSW said that apart from the point raised by Mr LEE, unstable condition of a patient would also delay admission to halfway house. She said that to strengthen services for discharged mental patients, the Administration would increase places in the existing halfway houses, urge the Housing Department and the Lands Department to allocate suitable sites for new halfway houses, co-operate with other support services to assist and accommodate discharged mental patients, and enhance the computer system in the coming year so as to improve matching of halfway house locations with patients.

Out-patient service

11. Mr LAW Chi-kwong was concerned about the waiting time for the first appointment at specialized psychiatric out-patient clinics, the daytime opening hours only, the short consultation time for each patient, and the assessment indicators of provisions of services such as the rate of re-admissions.

12. In reply to Mr LAW, CR and Executive Manager (Professional Services) (EM) provided the following information-

1. The average waiting time for first appointment at specialized psychiatric out-patient clinics was 9 weeks. However, due to increase in demand, the average waiting time as at August 1998 was 9.6 weeks. The HA would continue to work towards a shorter waiting time;

2. the HA had reservation about extending the service hours of psychiatric clinics to the evening. It had implemented a pilot project to extend the service hours of the Yaumati Psychiatric Centre since May 1998. A review of the utilization rate and effectiveness of the pilot project would be conducted shortly. A preliminary assessment indicated that it was not cost-effective as usage was low in the evening and it was costly to operate. Furthermore, as it was difficult to spare a medical social worker for the evening shift, it was not possible to provide comprehensive psychiatric service. Given that the demand in the morning session for psychiatric service was about 20-25 cases as compared to only 4-5 in the evening, it was not cost justifiable to replace a morning session with an evening session. As to Mr LAW's concern about discharged patients not being able to attend follow-up consultation during office hours, CR pointed out that most patients who had just been discharged were likely to be working part-time only owing to their working capabilities. If the patient's relatives favoured evening session because they wished to accompany the patient to attend consultation after working hours, then they should use the service more often;

3. Apart from psychiatric clinics, other specialist clinics such as those treating patients with chronic diseases had also requested that the working hours be extended. To extend the working hours of one service would have impact on others, as services were competing with each other for funding. It was therefore necessary to strike a right balance among the services concerned and to ensure a cost-effective operation;

4. The duration of each appointment for individual patients depended on the condition of the patient. For example, if the patient attended a scheduled appointment in a stable condition, it was not necessary for the psychiatrist to extend the consultation time. Arrangement for the next consultation would depend on the progress of the patient and the degree of medical service required by the patient; and

5. Since the treatment and rehabilitation services for mental patients were individualized and the rehabilitation progress varied from patient to patient, it was difficult to draw up a universal assessment indicators applicable to all mental patients. As a general rule, the unplanned re-admission rate of mental patients (less than 28 days) in Hong Kong was about 3%, which was similar to that of some overseas countries with well-developed psychiatric services.

Community and outreach services

13. Referring to the five Community Psychiatric Teams (CPTs) and the 12 Community Psychiatric Nursing Service (CPNS) Centres, Mr Michael HO asked whether the provision was adequate to meet the existing demand from discharged mental patients for community care services. CR replied that the fifth CPT was only established this year. It had helped to alleviate the workload of the four teams.

14. Mr Michael HO said that he was not satisfied with the answer. He noted that in the past years many services had been strengthened without incurring additional resources. Priority treatment was given to acute mental illness resulting in normal demand being neglected. He was concerned about the impact on provision of service in terms of quantity and quality. He asked the Administration to provide data on the supply and demand of community psychiatric service. CR affirmed that the HA had implemented a system in the out-patient psychiatric clinics to ensure that urgent appointments were offered to cases requiring immediate medical care. As regards resources, the HA would deploy community psychiatric nurses internally to meet service demand as far as practicable. If there were insufficient manpower resources, it would seek additional funding from the Administration. He said that it was difficult to assess the demand of the community psychiatric service but the HA would provide information on the caseload handled and visits paid by community psychiatric nurses, as well as the manpower resources in the CPTs and CPNS Centres.

Adm

Caseload

15. Noting that each medical social worker (psychiatry) handled 95 long-term cases and 655 short term cases in 1997-98, Mr Fred LI expressed concern about the heavy caseload and the limited time a social worker spent on a discharged mental patient during counselling. Deputy Director of Social Welfare (DDSW) explained that the figure quoted included new cases opened during the year. She said that at any one time, each medical social worker handled 70 long-term cases and 40 short term cases a month.

Hotline services

16. Mr Michael HO said that the 24 hours hotline services described in paragraph 29 of LC Paper No. CB(2) 411/98-99(01) were different from the arrangement he was aware of. To his understanding, the hotline service was manned by community nurse from 9:00 am to 5:00 pm and thereafter it was referred to the psychiatrist on duty through paging. EM replied that there were a number of hotline services including, among others, those provided by the HA and the outreaching teams which were operated on a district basis. The hotline service in the HA provided information relating to mental illness, rehabilitation and psychiatric services round-the-clock. At the request of Mr HO, the Administration undertook to clarify the arrangement of hotline services in writing.

Adm

Employment services

17. Noting that the successful placement rate for the discharged mental patients who had registered in the Selection Placement Division (SPD) of the Labour Department was 30% in 1997, Mr LEE Cheuk-yan asked about the situation in 1998. Miss Cyd HO enquired how the other 70% would be handled and whether the Government would take the lead to employ them. Senior Labour Officer (Selective Placement) (SLO) said that up to 30 September 1998, the SPD recorded 609 registrations and 144 discharged mental patients had successfully secured employment. The result was not satisfactory because it had not been easy to find jobs for discharged mental patients. As regards the other 70%, each job-seeker was given personal attention by a placement officer who would assess his skill, understand his problems and needs, provide counselling and arrange retraining programmes to strengthen his vocational skills as and when necessary. He said that the Administration had placed significant emphasis on public education campaigns with a view to promoting a better understanding and acceptance of mental patients by the community. With the public becoming more aware of the problems faced by discharged mental patients, it was hoped that more employers would consider their applications and hire them. Being the biggest employer in Hong Kong, the Government employed many persons with disabilities, including discharged mental patients. When a person with disabilities was considered to have met the minimum requirement specified in a post, an interview would be arranged.

18. In response to a further question from Miss Cyd HO, SLO said that no information was available on the number of discharged mental patients being fired as a result of his medical history, or because he had to take leave to attend a medical appointment. He said that the SPD had not received any complaints relating to discrimination. However, such complaints might have been lodged directly with the Equal Opportunities Commission (EOC). CR supplemented that if a job was arranged through the SPD, an employer would be advised in advance of the medical condition of the discharged mental patients. In this regard, the employers who agreed to take on discharged mental patients were likely to be accommodative. He said that while EOC had kept statistics on complaints arising from discrimination, breakdown on discharged mental patients might not be available, and it definitely would not reveal details of individual complaint cases to SPD or SWD.

19. As the meeting had to proceed to the next agenda item, members suggested and the Administration agreed that further questions, if any, should be forwarded to the Administration in writing after the meeting.

IV.Consultancy study on needs of elderly in Hong Kong for community support and residentialcare services

(LC Papers Nos. CB(2) 417/98-99(01-11), 433/98-99(01-03) and 443/98-99(01-02))

20.The Chairman informed members that in response to the press advertisements placed by the Panel, a total of 16 submissions had been received on the Study of the Needs of Elderly People in Hong Kong for Residential Care and Community Support Services (the Study) conducted by the Deloitte and Touche Consulting Group and that four deputations would be giving their views at the meeting. All the submissions had been forwarded to the Administration for its consideration and comments.

Meeting with deputations

21. The Chairman welcomed representatives of the Association for the Rights of the Elderly, the Hong Kong Council of Social Service, the Hong Kong Young Women's Christian Association - Chi Po Social Centre for the Elderly and the Hong Kong Psychogeriatric Association to the meeting.

Association for the Rights of the Elderly (ARE)

(LC Paper No. CB(2) 417/98-99(01))

22. Representatives of ARE said that details of their concerns were set out in the paper but they would like to highlight the following points -

1. The Study was completed in November 1997 but it was not until September 1998 that the report was released. The Administration should in future release this type of studies to the public as soon as possible. In this connection, they wished to know when the two studies on the level of physical and cognitive impairment conducted separately by the SWD and the Department of Health would be made available;

2. The Administration should advise on the recommendations that would be accepted and not accepted in the Study and the rationale behind the decisions;

3. In the Study, a methodology which focused on understanding the needs of the elderly for residential care and community services was used. ARE was of the view that the focus should be extended to cover the needs of family caregivers, given that more than half of the elderly persons were cared for by their aged spouses or middle-aged children carer who might also require assistance. Under the principle that residential care would only be provided to those who did not have access to informal caregivers, ARE pointed out that elderly needs for residential care service might have been under-estimated. The recent tragedy in Sau Mau Ping in which an aged mother died of starvation because of her elderly son had suddenly died at home illustrated that the above principle had overlooked the needs of elderly persons and their families;

4. The Study emphasised the control of resources and assessment of needs was based on the level of physical and cognitive impairment of the elderly. It failed to look at the needs of the elderly from a wider perspective and to propose proper services for these needs. The approach had deterred the elderly from expressing their need for services and deprived them the right to choose; and

5. The Study recommended the Government to consider adopting the policy of determining the ability of the elderly to pay for formal services based on the elderly and his family's assets and income. Given the proposal would increase financial pressure on the elderly and his family and it had far-reaching implications, the Government should give the proposal careful consideration.

The Hong Kong Council of Social Service (HKCSS)

(LC Paper No. CB(2) 417/98-99(02))

23. The representative of the HKCSS referred to the paper and highlighted the following points-

1. HKCSS supported the four principles of "Ageing in Place", "Role of the Family", "Continuum of Care" and "Mixed Economy of Provision". However, it had reservation about some of the recommendations made in the Study;

2. On "Role of the Family", the Study emphasised that it was the responsibility of the family to provide informal care to the elderly but it had neglected the constraints faced by family members. To achieve "Ageing in Place", a combination of services including residential, medical and other community support services should be made available to the elderly but the existing service delivery system tended to compartmentalize elderly needs. As rightly pointed out in the Study, despite the wide acceptance of "Continuum of Care", there was little evidence that this was being realized. One of the reasons was inadequate funding which had hampered the development of continuum of care. For example the infirmary care supplements to the subvented sector were interim measures which made it difficult to employ permanent and professional nursing and medical staff and hence affected the quality of service. In addition, there was no transitional arrangement for the elderly to move from one service to another, which should be an integral part of continuum of care. The Government should put more effort on strengthening community care services rather than tightening the admission criteria for residential care services;

3. Given that the needs assessment methodology used in the Study put more emphasis on the needs of the elderly who had a higher level of physical and cognitive impairment, and that the Study had over-estimated the role played by volunteers, family members and the private sector, needs of the elderly might have been under-estimated;

4. Having regard to the fact that existing residential care and community services provided by the private sector were of relatively low quality in comparison to the subvented sector, the Government should give due consideration to the recommendation that the provision of care services by the private sector should be encouraged;

5. The Study recommended the user-pay principle and suggested that the cost of premises to be included as part of the service cost. This would increase the financial burden on the elderly person's family and might deter elderly persons from using elderly care services; and

6. The Study used stringent assessment to ensure that the elderly did not receive more services than they needed. For instance, only domiciliary care and day care would be used to supplement the care informal caregivers were providing. The actual needs of the elderly were neglected.

Hong Kong Young Women's Christian Association - Chi Po Social Centre for the Elderly (CPSCE)

(LC Paper No. CB(2) 417/98-99(03))

24. The representative of CPSCE expressed her views on the Study as outlined in the paper. In gist, she was concerned about the training to be provided to elderly volunteer carers and she called for the provision of comprehensive elderly services to cater for different needs of the elderly.

Hong Kong Psychogeriatric Association (HKPA)

(LC Paper No. CB(2) 433/98-99(03))

25. The representative of the HKPA explained that psychogeriatry mainly referred to three kinds of mental illness namely suicidal tendency, depression and dementia. Dementia was a complex disorder that was characterized by cognitive impairment. Given that many health care professionals and family caregivers lacked adequate knowledge and skills in taking care of demented elderlies, it was not uncommon that demented patients were often accorded a lower priority in receiving care services. In this regard he would like to make the public understand more about dementia. He made the following points-

1. Many family members and community carers had experienced marked difficulties in caring for demented elderlies. They often experienced a sense of helplessness especially at the later stage of dementia. Support services to the family should be strengthened and where necessary, the demented elderly should be given residential care services;

2. Residential care services for demented elderly was inadequate. The Study revealed that elderly with severe cognitive impairment were under represented in the residential care population, given that the admission criteria for subvented residential care facilities explicitly excluded those not deemed suitable for community living. The admission criteria deprived demented elderly of access to residential care services and should be reviewed;

3. Community support services for psychogeriatric patients were grossly inadequate. He urged the Government to strengthen support services so as to achieve elderly care in the community rather than by the community. HKPA recommended the setting up of independent community psychogeriatric teams to strengthen the function of community outreach psychogeriatric services. The teams should comprise old age psychiatrists, community psychogeriatric nurses and community occupational therapists;

4. There was an increasing demand for psychogeriatric day hospital service but there were very few hospitals providing such service. HKPA supported the recommendation of setting up a psychogeriatric day hospital on the ratio of one day hospital to 50 000 elderly;

5. Drugs for the treatment of early stages of dementia should be introduced in Hong Kong ; and

6. The Study had not put enough emphasis on the prevention and management of elderly suicide and elderly depression.

Meeting with the Administration

26. Deputy Secretary for Health and Welfare (2) (DSHW(2)) thanked deputations for their views. He said that he would like to make the following points in order to clarify some misunderstandings which had surfaced -

1. The terms of reference of the Study were to assess the needs of elderly people in Hong Kong for residential care and community support services; to propose whether, and if so how, current services should be modified or replaced by new services to meet the needs of the elderly; and to propose ways in which the services identified could be provided in a cost-effective manner by the Government, the subvented organizations and the private sector. The recommendations made in the Study would not necessarily be adopted and implemented as policies. The Elderly Commission would study the recommendations of the Study and advise on the formulation of a comprehensive elderly care policy;

2. The needs assessment methodology based on impairment level of the elderly and informal caregiver availability was an internationally recognised method. The consultant had made it clear that it would be difficult to identify inappropriate demand and unmet need accurately. The mechanism adopted in the Study was a useful tool for macro planning. It did not suggest that the actual provision of residential care and community support services would be determined by these two factors only;

3. The result of the Study was not released to the public until September 1998 because the Health and Welfare Bureau and the SWD had been seeking the views of various advisory bodies, including the EC and Social Welfare Advisory Committee. For controversial issues such as the user-pay principle, it was necessary to conduct in-depth internal study before releasing the information to the public. Having regard to the implications of some of the controversial proposals and the unlikelihood that a conclusion could be reached in the short term, the Study was made public to solicit views;

4. On the inadequacy of residential care services, the Elderly Commission had submitted a report to the Chief Executive recommending a comprehensive strategy to improve residential care services. An ad hoc committee under the Elderly Commission, comprising members from different government departments and agencies, organizations, professions and community sectors, would be meeting in the following month to discuss ways to improve the existing domiciliary service;

5. The Elderly Commission planned to set up another Working Group in the following year to study the provision of medical services to the elderly. As regards care for demented elderly, the 1998 Policy Address had set out that the Government would extend coverage of Dementia Supplement in subvented residential care homes, conduct pilot schemes in day care centres and residential care homes and would provide training to front-line staff to identify elderly with traits of dementia; and

6. In 1996-97, expenditure for provision of elderly services amounted to some $16 billion, excluding medical and premises costs. With a elderly population, it would be difficult for the Government to finance the entire bill in future from taxation.

27. Mr Fred LI was concerned about the points raised in the submission from the Occupation Therapy Department of Kwai Chung Hospital (LC Paper No. CB(2) 433/98-99(02)) which pointed out that there was no infirmary for the elderly mentally ill and only one long-stay care home for the elderly on Hong Kong Island for which the waiting time was seven years.

28. DDSW replied that there were a total of three long-stay care homes providing 570 places to patients aged 15 and above, of which 170 places were provided by the elderly home quoted by Mr LI. There were at present 1 200 elderly persons on the waiting list and the average waiting time was three years. There was no priority arrangement for the elderly. By 2002-03, there would be two more long-stay care homes providing 800 additional places to patients aged 15 and above. She said that the HA did provide infirmary services to mental patients, although they were not for the elderly only. As to whether more long-stay care homes should be provided specifically for the elderly, DDSW said that it was necessary to assess the need.

29. Mr Fred LI enquired whether there were measures to prevent the re-occurrence of the Sau Mau Ping tragedy. DSHW(2) said that it would be inappropriate to discuss the case which was currently under investigation by the coroners. All he could say was that had the son made an application for his mother to be admitted to Care and Attention home, she could be admitted. DSHW(2) assured members that in a case where a frail elderly was taken care of by an elderly caregiver, the frail elderly would be eligible for residential care service. What the caregiver needed to do was to approach SWD for assistance. In the coming four years, 8 000 new subsidised places would be provided and elderly with a high level of impairment would have priority access.

30. Mr LAW Chi-kwong pointed out that it should not be the responsibility of the caregiver to decide whether or not an elderly person should be sent to elderly care homes, but the wish of the elderly should be respected. He asked about the admission criteria for residential care service. Assistant Director of Social Welfare (Elderly) (ADSW/E) said that she shared Mr Law's view on the first point. As regards the second point, there were a number of residential care services, the admission criteria differed from one service to another but they depended very much on the physical condition of the elderly.

31. Mr LEE Cheuk-yan noted that some of the recommendations made in the Study were already implemented and expressed concern about the lack of consultation. DSHW(2) explained that for straight forward issues that had community support, for example, enhancement on domiciliary services, the Administration would implement the recommendation upon approval by the Elderly Commission. However, consultation would be conducted for the more controversial issues such as the user-pay principle.

32. A few members considered that means-testing and the user-pay principle, if implemented, would deter elderly from seeking elderly care services. Mr LEE Cheuk-yan pointed out that the Community Survey quoted in the Study revealed that 76% of the elderly respondents said that they had just enough, enough, or more than enough funds to make ends meet. He was concerned about the ability of elderly to pay for a higher cost of service especially if they had not received sufficient financial support from their children. DSHW(2) replied that the Administration had not proposed any charging schemes at this stage and the Elderly Commission was currently concentrating on developing and improving elderly care services. The financial aspect would need further deliberation.

33. Referring to the comments made by the representatives of ARE in paragraph 22(a) above, the Chairman said that another organization had complained that the Panel had not invited views from the public earlier and she would like to point out that the Study was only made available to the Panel in September 1998. Mr LAW Chi-kwong requested the Administration to let members know the number and nature of the studies being conducted by SWD at present. DSHW(2) replied that a number of studies were being carried out, some of which were internal studies. He assured members that there were no secret studies and that the public would be fully consulted on issues of wide public concern. As regards the studies in the pipeline, he would keep members informed when they were ready to be released.

34. On the training of elderly voluntary carers raised by the representative of CPSCE, ADSW/E said that many volunteers assisted in social centres which provided social, recreational and educational activities for the elderly. There were a variety of training courses for voluntary carers and they might select courses in accordance with their interest, time and ability. Experienced volunteers might also be asked to assist in gathering views from the public on a voluntary basis. She said that it would be unrealistic to expect volunteers to provide regular service or replace the work of a formal carer, i.e. a permanent worker.

35. A representative of ARE was concerned about the psychological status of the elderly, given that the level of possible depression in the elderly population in the community was high (the Study revealed that 22% of elderly in the survey had scores on a psychological assessment scale which would be consistent with a diagnosis of depression) and that Hong Kong had one of the world's highest elderly suicide rate. DSHW(2) said that the percentage was purely an assessment and not actual diagnosis. Nevertheless, the Administration was also concerned about the problem and a working group had been formed under the Elderly Commission to study care services for the demented and to consider the prevention and management of elderly depression and suicide.

36. The representative of HKPA said that to enable members to have a better understanding of dementia, he would provide a paper on "Prevalence of dementia in Chinese elderly in Hong Kong" for members' reference. He also provided two kits entitled "Dementia Home Care Project" each containing a video tape, a cassette tape and first aid accessories. The Chairman instructed that the kits be kept in the Library.

(Post-meeting note: The information paper was issued to members vide LC Paper No. CB(2) 486/98-99(01))

37. The Chairman thanked the deputations and the Administration for attending the meeting.

38. The meeting ended at 1:00 pm.

Legislative Council Secretariat
9 December 1998