Geri-Orthopaedics International Conference on Prevention and

Management of Fragility Fractures among the Elderly

“Elderly Care – the Hong Kong Scenario”

September 11 2010

Dr. C.H. Leong

      Let me begin again by congratulating the organizer for arranging such a meaningful and timely symposium.  In congratulating you, let me also thank you for giving me the honour to deliver this keynote address.
      
       The topic assigned to me is Elderly care – the Hong Kong scenario.  Before I go further, let me declare my interests as an elderly, for at age of 71, I should now need or will at least very soon need elderly care.      

       I like to bring you through 2 phrases:

• The concept and policy of Elderly care in HK in the past;
• How the Elderly Commission has shaped, and hope to shape the concept of Elderly care to ensure a much more enriched golden age for our senior citizens.

The concept of Elderly Care and the Problems in the past

       Like it or not, there is no denial that elderlies are being looked at as a societal burden.

       Let us consider at some common phrases associated with the elderlies and ageing population.

• The “Dependency Ratio” will be rapidly enlarging; (Dependency Ratio is being calculated as the number of persons aged under 15 and those aged 65 and over per 1000 persons aged between 15 and 64); It implies that there will be less and less young working people, perhaps tax payers to support enlarging groups of elderly people who do not pay tax.

• Health care costs are rising exponentially because of an ageing population;

• Some 49% of our public hospital beds are being occupied by people 65 or above.

These and many others portrait the general believe that ageing population have brought the society to bear.
 
Even attempts at being kind to the elderlies are often cruel to them.  To wit, the common symbol of an elderly is a bent back individual, often bald or complete white hair with extensive wrinkles in the forehead waking slowing holding a walking stick or being assisted to cross a road.

              Regrettable, even discrimination against the elderly are by no means uncommon.

“Don’t ask grandpa, you wouldn’t understand” Is this a sign of fondness or a sample of discrimination or neglect?

           It might sound unreal, yet I have personally witness, demonstrations organized by young inmates and owners of public housing against the establishing of an elderly centre or an old age home in the same housing block. 

       To be fair, both our government and NGOs have organized quite an extensive numbers and networks of elderly care services.  Regrettable, they are never innovative, and often based on a welfare-orientated policy.
      
       There are many elderly day care centres or community care services centres established throughout the region both by government and NGOs.  They provide good welfare services for our senior citizens to while away their time – providing good and affordable meals, large TV screens showing repetitive “golden oldie” movies.  Is this what our elderlies want?
      
When an Elderly is assessed to need long term care, he/she is given the option of entering an institution —subvented elderly homes or subsidized place in private homes for the aged, or provisions for community care services to age in the community or at home.  But with community services, not geared for the user’s needs, most elderlies are “force” to move into elderly institutions.

Take the issue of health care - Yes, for a token sum, often waived, an elderly requiring medical care will be given the state of the art treatment in our public hospitals — fixing up fractures, even joint replacement.  Yet, before that individual is adequately rehabilitated, he/she is sent home because of shortage of hospital beds.  Such improper discharge will make it difficult for the family to take the elderly home, forcing them to look for elderly institutions for the patient,  against the wish of that elderly.  Worse, it invited higher rates of unscheduled readmissions if not further trauma.

Are we therefore caring for our elderlies with passion because they thoroughly deserve it, or are we just answering to a call by dishing out welfare?

  The elderlies themselves, to a certain extent, are also to be blamed.  Why do they have to label the years after retirement as “twilight” years?  Why do elderlies have to take a bleak attitude that they are “useless” and that every day is a waiting for the eventuality?  It is disheartening to see fit, active elderlies sitting in back alleys, at public squares, doing next to nothing except reading outdated newspapers and magazines.

  Finally, while in HK, there is no legal retirement age, why does our government have to take a lead to retire our experienced civil servants at the age of 60?  I am aware that I am treading on dangerous grounds for over two millions Frenchman took to the streets in France creating havoc through total labor strikes because government has proposed to extend retirement from 60 to 62.

What the Elderly Commission did and propose to the provisions of elderly care for today and the future

       Basing on those fallacies, the new team of Elderly Commission appointed in 2005, believe that we should think out of the box, engaged the individual elderly themselves, the family and the neighbourhood and the society at large, with facilitation by the government to embark on promoting an elderly care that will cater for the changing needs according in the following beliefs:

• We have to alter the image and perception of the elderly;
• We need to promote Active/Healthy Ageing amongst the senior citizens
• Along the way, we should promogate intergeneration harmony as a means to strengthen family core values; and
• We need to create a long term care service delivery that will provide dignity and quality care for our elderlies of every need.

• We want change the image of elderlies and the perception of the society to the elderlies.  Needless to say the elderlies themselves have to change their own mindset;

• On that basis, we have and will continue to promote active and healthy ageing through the establishments of the Elderly Academy.  Using primary and secondary schools as platforms, the students of those schools would act as teachers to teach the enrolled elders who will act as students on topics such as healthy living; moderns skills, such as use of computers, English language, Putonghua etc.   Elders are being kept active, they are being brought up to date with societal developments.  Through the process of interaction between the young and old , we promote intergenerational harmony.  Today, we have over 100 primary and secondary schools involved.  Eight tertiary institutions have joined the scheme.  Our elders, who, when they are young were deprived of formal education, now have a taste of University life.

• We would like to further promote active ageing through involving our elders in community activities.  This, we do through the “Neighbourhood Active Ageing Projects”.  Physically active elders will be recruited as core volunteers.  Under the supervisions of government and social welfare district officers and regional NGOs, they are trained to promote community relationships and networks.  Their tasks are to act as volunteers and through their peer relationships with neighbour to identify “hidden elders”, elders with risk of family abuses and with suicide tendencies.  We have extended the project to identify early Alzheimer aiming to provide early attentions, hopefully to prevent rapid deteriorations. Success stories are abundant.  Furthermore, these projects indicate that intergenerational, intersectional and multi-discipline collaboration could be mobilized to help those are in need on a neighborhood network.

• A moment ago, I was commenting on the plight of elderlies who are discharged form hospital unprepared.  This actually showed a lack of coordination between the health and the welfare sectors.  As of 3 years ago, we embarked on a project of “Hospital Pre-discharge Preparation Programmes”.  Elderlies admitted to hospital are being assessed on the services and needs at discharge to ensure full rehabilitation.  A programme will be tailored for each elder, their family, and provides intensive “one-stop” services for elders through the joint efforts of healthcare professionals and home care services’ teams. Elderly patients are provided with pre-discharge and post-discharge services such as formulation of discharge care plans and provision of transitional community care and support services through a Discharge Planning Team.  We have done 3 pilot projects, all with encouraging results.  We are hoping that those projects will be expanded to other areas of our community.

• As the population ages, there will be more old people requiring more and more Elderly help,, we have introduced the District-based Scheme on Carer Training since 2007, currently 158 elderly centres, 58 day care centres and 85 home care service teams throughout the territory are providing support services for carers, including the provision of information, training and counselling, assistance in forming carers' mutual-assistance groups, setting up of resource centres, and provision and loan of rehabilitation equipment, etc.  "More than 2,400 elderly carers have already been trained under the District-based Scheme while another 4,000 elderly carers will graduate soon.

• To the society today, 60 years old is fairly young.  People by that time would have reached the pinnacle of their career – matured and experience with the years of work.  Most are still healthy.  Yet, they are asked to retire.  It is a lost of talent, a waste of human resources.  It will increase the dependency ratio.  We are therefore lobbying for flexibility in retirement age.  We are encouraging big organizations to take a leading role, for we are confident, it will be of great help to the society.

Mr. Chairman, ladies, gentlemen, for the last 20 minutes are so, I have tried to outline some of our elderly care and the direction of policy behind them.  The care that the elders need will never be exhausting, nor do we boast to be able to do all.    The society at large must continue to strive to look for more and better ways to accommodate our senior citizens who is responsible for what this society is today.  Ageing is a must, it will happen to all.  As Alan Greenspan once said “Demography is destiny”.