Following is a question by the Dr Hon Lau Siu-lai and a written reply by the Secretary for Labour and Welfare, Mr Stephen Sui, in the Legislative Council today (June 28):

Question:

     On June 6 of this year, an old man allegedly strangled his wife to death.  It has been reported that the tragedy, which was the second case of the same type since January this year, was suspected to be caused by the old man's inability to withstand the pressure arising from prolonged caring of his old wife.  Some social workers have pointed out that the aforesaid case reflects the inadequacy of the services provided by the Government for the elderly and the support provided for their carers.  They have also pointed out that although the Social Welfare Department (SWD) has launched the "Pilot Scheme on Living Allowance for Carers of Elderly Persons from Low Income Families" (the Pilot Scheme) through the Community Care Fund, under which eligible carers are disbursed a monthly allowance of $2,000, the amount of the allowance is inadequate.  In addition, SWD has not yet provided across-the-board care services for the elderly and support for their carers through the case management approach.  In this connection, will the Government inform this Council:

(1) whether it knows the total number, in each of the past five years, of District Elderly Community Centres and Neighbourhood Elderly Centres operated by subvented organisations which provided outreach services for elderly singletons, persons in families of elderly doubletons and hidden elderly, as well as the manpower and expenditure involved in the provision of such services each year; whether it has reviewed if the current subvention provided by the Government for such services is sufficient; if it has reviewed, of the details; if not, the reasons for that;

(2) whether it has planned to provide across-the-board care services for the elderly and support for their carers through the case management approach, under which case managers continuously co-ordinate and make referrals on the care services needed by the elderly and the support needed by their carers; if so, of the details; if not, the reasons for that; and

(3) given that SWD has commissioned a research centre to evaluate the effectiveness of Phase II of the Pilot Scheme, of the latest progress of the evaluation; whether the authorities will improve the Pilot Scheme by, for example, (i) relaxing the eligibility criteria (including waiving the means tests of carers and reviewing the requirement on the number of hours of care-giving work carried out for the elderly per month), (ii) increasing the amount of the Living Allowance, and (iii) regularising the Pilot Scheme, as well as formulating and implementing a carer allowance policy; if so, of the details; if not, the reasons for that?

Reply:

President,

     "Ageing in place as the core, institutional care as back-up" is the Government's fundamental elderly care policy. In fact, ageing in place is the cherished wish of most elderly persons.  With adequate community care and support, many elderly persons with long-term care needs can still continue to age in their own place. Carers also play a vital role in helping elderly persons age in place. As such, the Government provides a range of centre-based and home-based community care services at the community level through 73 Day Care Centres/Units for the Elderly, 34 Enhanced Home and Community Care Services Teams and 60 Integrated Home Care Services Teams to help elderly persons age in place. In addition, a total of 210 subvented elderly centres (i.e. District Elderly Community Centres (DECCs) and Neighbourhood Elderly Centres (NECs)) in 18 districts over the territory provide various support services for elderly persons and carers at the district level, such as counselling, referral, assistance in handling long-term care service applications, emotional support, health education, arrangement for social and recreational activities, meal services, carer training, etc. The estimated expenditure for subsidised community care and support services for the elderly in 2017-18 is about $2.3 billion.

     My reply to the question raised by Dr Hon Lau Siu-lai is as follows:

(1) Currently all the 210 subvented elderly centres would provide outreaching services for hidden and vulnerable elderly persons in the community (including elderly singletons and families of elderly doubletons). The social workers of these elderly centres would, in the course of delivering the services, ascertain the support network of elderly persons and their families (for instance, whether the elderly person is living with his/her family or whether he/she has adequate support from relatives or neighbours), thereby facilitating the provision of appropriate services for them.  Further, the Support Teams for the Elderly under the 41 DECCs across the territory would identify potentially vulnerable elderly persons through various outreaching services and community networks, including setting up mobile booths in the districts, handling referrals from other social welfare units, etc. The teams would show care for elderly persons through regular telephone contacts and home visits, provide them with emotional support and counselling according to their needs and refer them to formal services, so that elderly persons in need (including elderly singletons and families of elderly doubletons) can receive appropriate support.

     As regards the manpower and expenditure of subvented elderly centres, the Government has since 2007-08 provided an additional full-year recurrent funding of about $42 million for all the DECCs and NECs in the territory at that time, so that each of them could recruit one more social worker to enhance the outreaching services for elderly singletons and hidden elderly persons. Since 2008-09, the Government has further provided a full-year recurrent funding of about $18 million for each DECC to recruit one additional social worker to strengthen the casework services for elderly persons, including counselling and referral services. Separately, starting from 2014-15, the Government has allocated a further full-year recurrent funding of some $135.5 million to all the 210 subvented elderly centres in the territory for, among others, upgrading the services of 51 social centres for the elderly to NEC level as well as increasing the manpower and programme expenses for 210 subvented elderly centres. The purposes are to enhance information dissemination, counselling services, carer support, etc. with a view to providing better support services for elderly persons and carers living in the community.

     Overall speaking, under the Lump Sum Grant Subvention System, service operators have the flexibility to deploy resources and arrange suitable staffing to meet the requirements as set out in the Funding and Service Agreements. In order to enhance the Social Welfare Department (SWD)'s transparency of subventions calculation, SWD has been uploading the consolidated Notional Staffing Establishment (NSE) samples of subvented services to its webpage. It should be noted that NSE is only used for calculating the subventions for subvented services and should not be used for benchmarking the manpower and staffing structure of the subvented services. The existing NSEs of social workers applicable to DECCs and NECs are tabulated as follows:
 

Service type	Number of social workers under NSE
DECC	11
NEC	4.25

 
(2) Under the First Phase of the Pilot Scheme on Community Care Service Voucher for the Elderly launched in September 2013, the Recognised Service Providers (RSPs) would conduct case management, formulate individual care plans for voucher users based on their care needs, and review and update the care plans on a regular basis. Under the Second Phase of the Pilot Scheme launched in October 2016, in addition to the above case management being continuously conducted by RSPs, SWD has set up a Centralised Team to serve as the first point of contact for elderly persons interested in using the vouchers and their carers. The Centralised Team will also provide dedicated support and assistance in collaboration with Responsible Workers, including the provision of information on RSPs and assistance to elderly persons and carers for deciding whether to apply for vouchers and selecting suitable RSPs and community care and/or support service packages (e.g. rehabilitation exercise, personal care service, carer training, etc.), as well as switching RSPs when necessary, etc.

     To strengthen community care for elderly persons and to help them age in place, the Government will launch the Pilot Scheme on Home Care and Support for Elderly Persons with Mild Impairment and the Pilot Scheme on Support for Elderly Persons Discharged from Public Hospitals After Treatment in the fourth quarter of 2017 and the first quarter of 2018 respectively at the earliest. The Pilot Scheme on Home Care and Support for Elderly Persons with Mild Impairment will also incorporate the case management approach. Service providers will be required to, with reference to the assessment results and the physical health conditions of eligible elderly persons, discuss with elderly persons and their carers and formulate individualised care plans for elderly persons to choose suitable service providers and service packages based on their needs to receive single or multiple home-based meal and/or home services (e.g. home cleaning, support to carers, etc.). Service providers will also have to arrange elderly persons to receive services for preventing functional deterioration (e.g. physical exercises, personal health management, etc.) and keep the cases under regular review to ensure the provision of appropriate services for elderly persons. 

     As regards the Pilot Scheme on Support for Elderly Persons Discharged from Public Hospitals After Treatment, SWD will set up a Discharge Support Team mainly comprising social workers. The Discharge Support Team will work closely with the relevant hospitals to formulate the discharge support plans for elderly persons according to their needs and arrange them to receive post-discharge community rehabilitation services and transitional residential care and/or community care and support services (e.g. personal care, day care services, carer support services, etc.) for not more than six months in total. Service providers will have to cater to the individual needs of service users in the provision of services. Social workers of the Discharge Support Team will formulate individualised care plans for elderly persons and regularly assist in reviewing their various aspects of conditions in the course of service delivery, evaluate their post-transitional service needs in a timely manner for making service referrals as appropriate, so as to seamlessly connect elderly persons to the required long-term care services where practicable and provide them with sustained support to age in place.

(3) The Government introduced in June 2014 the Pilot Scheme on Living Allowance for Carers of Elderly Persons from Low Income Families with funding from the Community Care Fund to provide carers of elderly persons from low-income families with a living allowance to help supplement their living expenses, so that elderly persons in need of long term care services can, with the assistance of their carers, receive proper care and continue to live in a familiar community. Phase II of the Pilot Scheme was rolled out in October 2016 and would be implemented for two years. In order to benefit more eligible carers, an additional 2 000 places are provided under Phase II of the Pilot Scheme to make a total of 4 000 beneficiaries for the entire Pilot Scheme. Under the Pilot Scheme, a living allowance of $2,000 is disbursed monthly to each eligible carer. Carers taking care of more than one elderly person at the same time can receive a maximum allowance of $4,000 per month. DECCs and NECs serve as the service providers under the Pilot Scheme to provide necessary support and follow-up services for carers and elderly persons, including arrangement for training, home visits, emotional counselling for carers when necessary, etc.

     SWD has commissioned the Sau Po Centre on Ageing of the University of Hong Kong to conduct an evaluation on the Phase II of the Pilot Scheme together with the Pilot Scheme on Living Allowance for Low-income Carers of Persons with Disabilities that was also launched in October 2016, with a view to helping the Government consider the way forward for both schemes. The related matters, including the eligibility criteria, the amount of allowance, whether the Pilot Scheme is to be regularised, etc. will then be reviewed in one go. The evaluation study is expected to be completed in the third quarter of 2018.

Ends/Wednesday, June 28, 2017
Issued at HKT 12:40

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