Elderly people could age at home with help

Elderly Hongkongers are being pushed into nursing facilities. But with the right help, they could live out their days more independently

PUBLISHED : Monday, 09 September, 2013, 12:00am
UPDATED : Monday, 09 September, 2013, 12:59pm

Lee Fung-kiu still manages a few steps with a walking frame, but her legs aren't what they used to be. Largely wheelchair-bound, she once relied on her husband for many everyday tasks. So his death last year was devastating on many levels.

"I had been living in [Cho Yiu Chuen] estate with my husband for over two decades. My life took a turn for the worse after he died," the 81-year-old says. "As I couldn't stand up to turn on the lights [at night], my home was dark for several months after his death."

I couldn't stand up to turn on the lights, so my home was dark for several months
Lee Fung-kiu

It wasn't until the Housing Society helped her move into a customised flat within the Kwai Chung estate in July that her situation improved. The layout of her new home was tailored to her special needs: light switches were installed at a lower height, as were the wash basin and kitchen counter, and the bathroom entrance was widened for wheelchair access.

The renovation, which cost HK$50,000, is part of Ageing in Place, a Housing Society programme introduced last year to enable the elderly to continue living in their own homes for as long as possible, instead of entering nursing homes. Other measures include setting up a rehabilitation centre on the estate, and organising volunteers to pay regular visits to the elderly.

Lee has been much happier since moving to her new flat. "A neighbour now comes to boil water and cook rice for me. She's also here when I am bathing in case I fall. She even comes when typhoon No 8 is hoisted."

This month, the Social Welfare Department launched a pilot scheme to provide up to 1,200 elderly people with monthly vouchers worth HK$5,800 to pay for community-based care. This covers day-care centre services or help from NGOs with household chores.

Designed to encourage people to age within their community, the scheme requires recipients to forsake their place on the waiting list for subsidised care homes.

However, gerontology experts say there's a dearth of programmes to promote more congenial old age. Ballooning costs for elderly care aren't just the result of misjudging the rate of ageing, which government advisers highlighted last month. It also stems from extensive reliance on institutionalised care.

Besides being the fastest ageing society in the world, Hong Kong also leads in the way when it comes to the institutionalisation of the elderly - 6.8 per cent of the about one million Hongkongers above 65 years old live in care homes compared with 3 per cent in Japan, 4 per cent in Australia and 1 per cent on the mainland.

The government spends nearly seven times more on subsidised elderly homes (HK$2.5 billion in 2010) than community-based care (HK$380 million, in the same year).

But this ratio of spending should really be reversed, says Cheung Moon-wah, the Housing Society's general manager of elderly services. Quality of life in available care homes is often unsatisfactory. Furthermore, community schemes help senior citizens maintain social ties.

"The elderly should only enter an institution at the very last moment of their lives," Cheung says.

After a successful trial in Cho Yiu Chuen, the Ageing in Place programme was extended to seven other Housing Society estates in April. The HK$15 million annual cost, mostly for household modification works, is covered by the society's corporate social responsibility initiative.

Ultimately, it aims to address the needs of about 30,000 elderly tenants in all 20 society-run housing estates.

However, most of the elderly who live in Housing Authority public estates are far less fortunate, says Elderly Commission chairman Alfred Chan Cheung-ming.

"Over 50 per cent of elderly people live in public housing estates. Many are on welfare and do not have much money for home improvements," says Chan.

"If the flats and common areas in a housing block are not elderly friendly, many people who could live at home would be forced to go into a nursing home, which will cost the government more to run.

"The Housing Authority should follow the lead of the society to launch similar initiatives to promote community-based ageing."

The government has yet to conduct any study on how buildings can be made elderly friendly, Cheung says, although attitudes are starting to change.

"No one cared much about the issue before. But with the population ageing so rapidly, people recently began to pay more attention."

Addressing the needs of the elderly is an increasingly pressing issue, as the proportion of the population aged 65 and above is expected to rise from 13 per cent to 28 per cent by 2039.

But it takes the collective effort of many parties to successfully implement community-based ageing, Cheung says.

"For our Ageing in Place programme, we lined up the South Kwai Chung Service Centre and Princess Margaret Hospital, which sends nurses to the estate to conduct consultations with the elderly every week. More serious cases will be fast-tracked to hospitals for further treatment. NGOs send helpers to assist [frail residents] with household chores. Even nursing students are recruited to provide occupational therapy.

"Many beneficiaries of the scheme are queuing for places in subsidised homes and services [provided by the Social Welfare Department]. But there's a long waiting list. We help plug the service gap."

Government-supported homes, operated by charities such as Caritas and Pok Oi Hospital, currently provide places for 26,300 elderly people. Because they are generally well-regarded and heavily subsidised, there is a long waiting list for a vacancy.

As of the end of June, the Social Welfare Department recorded 29,200 people on the waiting list. The waiting time over the past five years has ranged from 23 to 35 months. As a result, about 4,600 people die each year before they get a slot.

Private nursing homes provide 51,800 care places for the aged - about 60 per cent of slots available - but standards can vary enormously. Many operate out of premises previously occupied by restaurants, and often are inadequately staffed to tend to residents, most of whom are bed-ridden.

The poor conditions explain why there is an overall 24 per cent vacancy rate at the city's 565 private nursing homes, although subsidised centres with a congenial environment are constantly full.

Meanwhile, about 990 elderly people who require help at home after being discharged from hospital must wait about three months for assistance under Integrated Home Care Services.

The government-subsidised scheme gathers 84 teams that provide help, such as delivering meals to elderly residents, but such services lack flexibility, Chan says.

"The six weeks after hospital discharge is critical. If patients receive enough community care in this period, they can usually remain at home afterwards."

The problem is most support services only work from 8.30am to 6pm. But many elderly people need around-the-clock care.

However, the voucher scheme could be expanded to include the private sector, as well as social enterprises, which are more inclined to provide 24-hour services.

Many elderly people are sent to care homes after they are discharged from hospital even though they might be better off at home, Chan says.

Often, an elderly person is injured in a fall at home, is treated and discharged from hospital, but family members may be too busy to deal with follow-up visits to doctors.

"Social workers at hospitals always recommend that the family sends the patient to a home as they are afraid they will fall again and require further hospitalisation. Once the elderly person is sent to a home, social workers heave a sigh of relief even if this is against the wish of the patient."

Lee Fung-kiu shudders at the thought of having to enter a private nursing home.

"I love cleanliness. I can't stand the smell in elderly centres. Many of my friends died soon after they were sent to the centres."

Senior education needed

Any boost in resources for ageing in place must be accompanied by a campaign to educate the community on the concept, gerontology experts say.

Many families don't realise they can seek help in caring for frail parents through schemes such the Integrated Home Care Service because there is a severe lack of publicity about such resources, says Elderly Commission chairman Alfred Chan Cheung-ming. "They don't know such things are available."

A lack of publicity also resulted in a poor response to a recently introduced voucher scheme to pay for community care. Although the Social Welfare Department allocated funds for 1,200 people under the project, only about 200 signed up.

The government needs to step up efforts to educate the community about ageing and elderly care, Chan says.

"One third of people in Hong Kong are going to be elderly ... Education for family members could make a big difference and help reduce institutionalisation of the elderly from 6.8 per cent to 4.5 per cent."

A programme initiated last year by the University of Hong Kong's Sau Po Centre on Ageing showed that informed family members can delay the institutionalisation of dementia patients.

The six-month programme involved home visits and counselling sessions for about 250 families with elderly members suffering from dementia, to help them cope with the stress of caregiving.

Centre director Terry Lum Yat-sang says training caregivers how to deal with dementia is more effective than medicating patients.

"While psychotropic drugs can help with behavioural problems, they are mostly for symptomatic relief," he says.

"But an able caregiver can make the lives of both patients and family members much easier."

Elaine Yau