Purpose

To inform Members of the recommendations of the Elderly Commission's Ad Hoc Committee on Housing and Residential Care for the elderly.

Background

2. In his 1997 Policy Address, the Chief Executive asked the Elderly Commission to assess the demand of the elderly for housing and residential care services and recommend a strategy to meet the long-term needs. An Ad Hoc Committee on Housing and Residential Care was convened to carry out the task.

3. The terms of reference of the Ad Hoc Committee are as follows:

1. To review the supply and demand for elderly housing and residential care places with a view to increasing the supply to meet the demand in accordance with agreed policy.
   
   
2. To keep under review public housing allocation policies affecting the elderly, including the various priority schemes for the elderly, with a view to achieving the policy objective of ageing in place. Where feasible, improvements to current policies and new initiatives that can help to further the policy objective should be considered.
   
   
3. To keep under review admission criteria and arrangements to various types of residential care homes, with a view to achieving the policy objective of continuum of care. Where feasible, new initiatives that can help to improve delivery of services should be considered.
   
   
4. To undertake any task in relation to housing and residential care assigned by the Elderly Commission.

4. The Ad Hoc Committee completed its work in September 1998. The Elderly Commission endorsed the Committee's findings and submitted the report to the Chief Executive in October 1998. A copy of the report is attached. The following is an outline of the report.

Policy direction on care of the elderly

5. The Ad Hoc Committee sets forth its direction on care of the elderly. It re-affirms that "continuum of care" is central to the policy on care for the elderly. Elderly people, whether living at home or in residential institutions, should be able to stay in a familiar environment when their health conditions change. The Government should continue with its public housing allocation policy and taxation policy to encourage families to care for their elderly as well as strengthening support services to assist elderly people who choose to live at home. In this regard, the Government should promote understanding between the two generations to narrow the communication gap. For elderly people who cannot be properly cared for at home, the Government should continue to develop residential services to meet their needs.

6. It was recommended that private property developers should be encouraged to develop flats with suitable facilities for the elderly. Moreover, a policy should be devised for private residential care homes to provide basic conditions for the private sector to operate in the market.

7. The Government should also facilitate the development of a mixed economy of service provision in order to offer more choices to the elderly and to raise the service quality though healthy competition.

Demand for elderly housing

8. According to the Housing Bureau's projection, the total demand for 1-person and 2-person assisted rental housing in the next ten years is 73,730 units, and the total supply would be 68,560, the shortfall being 5,170. The Housing Bureau would establish a system to review the demand situation and continue to address the housing demand of the elderly by providing suitable and affordable accommodation with the necessary supporting facilities, as well as taking into account their non-quantitative needs, such as preference for familiar neighbourhood and self-contained flats.

Public housing allocation

9. The Housing Authority has in place various priority schemes on admission to public housing for the elderly. These schemes benefit the elderly as well as the families willing to reside with their elderly. To further promote family care for the elderly people, the Housing Authority has recently improved elderly priority schemes, such as extending the Families with Elderly Persons Priority Scheme to non-nuclear families with elderly members and further reducing waiting time by advancing credit waiting time from one year to two years.

10. To reflect the different needs of elderly people of various age groups and health conditions, the Ad Hoc Committee recommends that, inter alia, more concessions in waiting time and flat allocation be given to families that take care of elderly with impairments and to the "older" olds.

Demand for residential care services

11. According to survey projection, of the 27,000 elderly persons on the waiting list for residential care, about 13,000 meet the admission criteria. During the next four years, there will be a supply of about 4,000 residential places each year, the estimated genuine demand is between 1,700 and 3,300. The number of places available for allocation in each of the following four years, except for 2001/02, will therefore exceed the net increase in genuine demand in the same year. This will gradually shorten the care and attention home waiting list and the waiting time.

Defining genuine demand

12. In defining genuine demand, residential care services should be directed to elderly people with genuine needs. In the longer term, Home for the Aged and Care and Attention Home should adopt the same set of admission criteria. Able-bodied elderly and those who can take care of themselves should age in the community with provision of support services.

13. The Government will be setting up a Gate-keeping mechanism in elderly services. When making applications for residential or social services on behalf of the elderly, caseworkers will refer the elderly to the Gate-keepers, who will then assess their health conditions and needs for nursing care. Taking into account the service resources and urgency of their need for services, the Gate-keepers will submit applications to the providers to arrange appropriate services for the elderly. By adopting a standardised assessment tool, assessments will be more objective and efficient than at present and would avoid duplication in assessment work..

Supply of residential care places

14. In order to increase the supply of residential care places within a short period of time, the Ad Hoc Committee agrees to further raise the utilisation rate of existing places and recommends subvented care homes to advance processing time to receive applications before vacant places arise. The Government should also continue to buy residential places from private care homes.

15. Under established policy, the Government would provide purpose-built premises for subvented care homes while most of the private care homes are located in non-purpose-built premises, converted from domestic or commercial units. These premises are not conducive to development of quality service. The Ad Hoc Committee recommends to extend the policy of provision of purpose-built premises to private care homes participating in the bought place schemes and self-financing care homes.

16. The Administration is also planning to develop sites reserved for community centres into joint-user buildings to accommodate residential care homes. At the same time, it is identifying more existing buildings suitable for care home purposes, such as vacant commercial premises or ex-government staff quarters. This measure will increase the supply of residential care places and gradually phase out care homes located in substandard premises.

Self-financing residential care homes

17. "Self-financing homes" are non-profit-making elderly homes operated by NGOs without Government recurrent subvention. The Ad Hoc Committee recommends that a suitable operating environment should be created to further encourage the setting up of more self-financing homes, such as providing suitable premises and financial assistance through the Enhanced Bought Place Scheme, operation of both subvented and self-financing residential places in the same home, and allowing recognition of the qualification and provident fund of non-professional staff of self-financing homes on being employed at subvented care homes.

Private residential care homes

18. Most of the private care homes are located in premises converted from private domestic flats or shopping arcades. Apart from in-situ constraints, their operation may be subject to objections from other tenants on grounds of contravening building usage restrictions. Another difficulty facing private care homes is the problem with staff recruitment and retention, given the long working hours and low wages.

19. The provision of purpose-built premises for private care homes participating in the bought place schemes would help to ameliorate premises-related problems. Through higher purchase prices in the Enhanced Bought Place Scheme, the Government also provides assistance to private home operators to recruit staff at higher wages. Moreover, the Administration is following up on proposals on manpower training, such as the supply of Health Workers and improving their professionalism.

Enhanced Bought Place Scheme

20. The Ad Hoc Committee has endorsed an Enhanced Bought Place Scheme designed to provide financial incentive to encourage private care home operators to improve their service quality. To strengthen monitoring of the service quality, the Administration will extend the concepts of service quality standards and monitoring to the participating care homes.

Private sector participation in provision of premises for care homes

21. The Ad Hoc Committee has made a number of proposals to the Government to encourage the private sector to supply accommodation for residential care homes. They include requiring the provision of premises for care homes as a condition in land sales, granting building concessions, relaxing the relevant regulations when examining applications to convert shopping arcades into care homes. The policy bureaux and departments concerned are following up these recommendations.

A sense of belonging

22. On the other hand, the Administration should continue to encourage and facilitate the elderly to age at home, and also to focus on providing residential care services for the frail elderly who cannot receive adequate care in the community. To examine in depth the policy on community support services, the Elderly Commission has set up an "Ad Hoc Committee on Home Care" to carry out studies on the topic.

Continuum of care

23. At present, when their health conditions deteriorate, elderly people have to be transferred to other care institutions according to their care needs. To enable elderly people to age in a familiar environment, the Ad Hoc Committee reaffirms the importance of "continuum of care' in residential care services.

24. Under the concept of "continuum of care", residential care homes should be provided with the appropriate facilities and staffing, so that they can meet the health care needs of the elderly residents whose health conditions change constantly. The Government has since 1996 issued infirmary supplements to care and attention homes to enable them to recruit extra staff to meet the care services need of the elderly.

25. To further the concept, the Ad Hoc Committee proposes that in future, subvention should be based on the care needs of all elderly residents in a care home, having regard to their different levels of frailty. A two-year pilot scheme should be launched at two care and attention homes to test the results.

The way forward

26. A summary of the main recommendations of the Ad Hoc Committee is at the Annex. Policy bureaux and government departments concerned are following up the recommendations in the report. Regular reports will be made to the Elderly Commission on the progress made.


Health and Welfare Bureau
January 1999

ANNEX

The main recommendations of the Ad Hoc Committee is summarised as follows:

Policy direction on care of the elderly

1. "Continuum of Care" should be the core of government policy on care for the elderly.
   
   
2. Care by the family plays a very important role in care for the elderly. The Government should encourage and assist families to care for the elderly through public housing allocation and taxation measures.
   
   
3. The Government should, through various channels and measures, promote strengthening of communication between the older and the younger generations.
   
   
4. The Government should respect the elderly's right to choose and provide sufficient public housing units for single elderly or elderly couples.
   
   
5. The Government should strengthen support services, improve respite service, and consider increasing professional support in outreaching teams. Services should be provided to carers according to their needs to enable them to better care for the elderly.
   
   
6. The Government should devise policies to encourage private developers to provide housing units with suitable facilities for sale or lease to the elderly.
   
   
7. The Government should continue to develop residential care services according to needs.
   
   
8. The Government should create an environment conducive to healthy competition, in tandem with the development of a mixed economy of service provision, to offer more choice to the elderly and raise service quality through competition in the market.
   
   
9. The Government should devise a policy for private residential care homes to provide basic conditions for the private sector to operate in the market.
   
   
10. When the mixed economy of service is well developed, the Government can consider concentrating on purchasing services.
    
    

Demand of the elderly for housing

11. When calculating the demand of the elderly for housing, the Housing Bureau should take into account the demand generated from revision of admission criteria of Homes for the Aged.

Demand of elderly for residential care services

12. The Health and Welfare Bureau should review the interface of services of residential care homes and infirmaries.

Public housing allocation for the elderly

13. More concessions in waiting time and flat allocation should be provided to families that take care of elderly with impairments.
    
    
14. As with arrangements in overseas countries, the Housing Department should consider according more concessions to the "older" old, say those of 75 years of age or over.
    
    
15. The Housing Department should consider a review of the Estate Liaison Officer scheme.

Residential care services

16. The Health and Welfare Bureau should consider how to interface with the Housing Department to care for the elderly who have a housing need but do not meet admission criteria of residential care homes.
    
    
17. The Social Welfare Department should consider buying more residential care places, having regard to resources available and the response of the market and of the elderly.
    
    
18. The Social Welfare Department should improve the utilization rate of existing residential care places.
    
    
19. The Social Welfare Department should follow up with the welfare sector the arrangements to convert Home for the Aged places into Care and Attention Home places, having regard to resources available.
    
    
20. An inter-departmental Strategic Group led by the Director of Social Welfare to consider how to increase the supply of premises for residential care homes, such as through leasing or tendering out suitable government premises (e.g. ex-staff quarters) and vacant units in pubic housing estates, development of sites reserved for community centres, etc.
    
    
21. The Government should extend to private and self-financing residential care homes the policy of providing purpose-built premises.
    
    
22. The Government can include suitable conditions requiring the provision of accommodation for residential care homes in land sale programme or when approving lease modification applications.
    
    
23. The Government should consider exempting residential care homes licensed by the Social Welfare Department from usage restrictions in land lease and building occupation permit.
    
    
24. The Government should consider extending health and specialist outreaching services to self-financing care homes and private care homes participating in bought place schemes.
    
    
25. The Ad Hoc Committee on Home Care to be set up by the Elderly Commission can consider in greater detail the policy on community support services.

Self-financing residential care homes

26. When planning new self-financing care homes, the Social Welfare Department to consider allowing the operation of both subvented and self-financing residential places in the same home to enable flexible use of resources.
    
    
27. The Social Welfare Department should extend the "Enhanced Bought Place Scheme" to self-financing care homes.

Private residential care homes

28. Operators of residential care homes should engage the service of Authorised Persons to assist them in dealing with the various safety/precautionary requirements regarding building, fire, electrical and gas installations under the Residential Care Homes (Elderly Persons) Ordinance.
    
    
29. Having regard to the needs of the industry and the wastage rate of graduate trainees, the Social Welfare Department should operate more Health Worker training courses and to form a working group to strengthen the training course to meet the manpower needs.

Bought Place Scheme

30. In the future, when it is necessary to revise the user fees under the Enhanced Bought Place Scheme, the Social Welfare Department should take into account the costs of providing health and care services.
    
    
31. The Social Welfare Department should extend the concept and monitoring of service quality standards to private care homes participating in the enhanced scheme.

Continuum of care

32. The Social Welfare Department should launch a two-year pilot scheme on the "continuum of care" concept at one or two residential care homes.