Time to rethink care home policy

Auditor's reports seldom lend themselves to compelling headlines. "Death stalks old as they wait for help", on our front page last week, is an exception. It was heading on a report about independent scrutiny by the Audit Commission of the assessment system for people on a three-year waiting list for aged-care places. Sadly the heading was not unjustified. The commission found that 5,700 people died last year while waiting to enter care homes, compared with an average of 4,000 to 4,500 deaths a year before 2010.

It also expressed concern about a couple of other administrative issues affecting an ageing society's most vulnerable members. The Social Welfare Department excluded from a waiting list of 39,690 a further 6,800 people assessed as eligible but either receiving community care services or on a "dual track" of either waiting for a place or remaining in the community. This downplayed the shortage. The audit also said the fact that 36 of 2,700 accredited assessors did 70 per cent of assessments raised efficiency questions.

The government spent more than HK$4.36 billion in the past year on elderly homes and community care services, part of a much larger budget for elderly services, but less than the land premium for a residential site. The number of care-home spaces has risen only 20 per cent since 2000, a shortage worsened by a perception of quality control issues in private care homes or government-bought spaces in private homes.

High property prices have contributed to cramped living conditions, a low birth rate, an ageing society and small households - all negative for traditional family care of the elderly. As a result the government faces an ever-lengthening queue for alternatives at an ever-rising cost. It can play catch up, or it can engage the public on a realistic strategy to meet and fund future needs, which should nurture a community and home care culture alongside care homes. That means taking account of people living longer and an increase in the incidence of dementia from one in 10 people in their 70s to three in 10 in their 80s. Ultimately families struggle to cope with the burden of advanced dementia. Few countries have kept up with the demand for medical and nursing care.

Meanwhile, it is good to hear the department agree with the director of audit's recommendation to continue striving to expand subsidised community and residential care services. Positive results would be a good first step.