1. Challenges of Long Term Care Needs in the Ageing Population in Chinese Communities
Dr. Edward MF Leung
President
Hong Kong Association of Gerontology
15th World Congress on Long Term Care in Chinese Communities 2018 Hong Kong

2. Need of Long Term Care in Ageing Population
The Demand on Long Term Care in an ageing population
Determinants of the Needs of Long Term Care
Coping with increasing need of Long Term Care
Financing of Long Term Care

3. The rapid phase of population ageing in the chinese communities

4. 2000

5. 2000

6. 2000

7. 2000

8. 2000

9. 2025

10. 2025

11. 2025

12. 2025

13. 2025

14. 2050

15. 2050

16. 2050

17. 2050

18. 2050

19. Determinants of Long Term Care Need
Population Ageing
Incidence of disabling chronic illnesses
Functional Status of older people
Family support for older people
Community support

20. Residents per 1,000 population
Nursing Homes Residents per 1,000 Population by Age, Sex and Race/Ethnicity, 2004 (US)
Female
Male
Residents per 1,000 population
Data Source: The National Nursing Home Survey

21. Population ageing Distribution in age structure
Young old against old old ratio
Female outlive male

22. Disabling illnesses Cerebrovascular diseases Dementia Parkinsonism
Alzheimer
Vascular dementia
Parkinsonism
Fracture
Osteoarthritis
End stage heart, chest and kidney diseases

23. Functional abilities of older people
Instrumental Activities of Daily Living
Activities of Daily Living
Mobility
Cognitive function
Feeding function
Falls
Bowel and Urinary incontinence

24. Family support of older people
Size of family
Extended family against nuclear family
Family relationship
Migration of family member from rural to urban area and from one country to another country

25. Community support
The need of formal long term care services especially Institutional Care depends much on the presence or absence of adequate community support for the older people and their family

26. Coping with increasing need of long term care
Prevention of diseases in old age
Fostering family relationship and family support
Enhancing community support services
Carer support

27. Prevention of diseases in old age
Life style modification for late adulthood
Dietary habit
Anti-smoking
Exercise
Reduction of obesity
Early detection and treatment of diseases
Hypertension and Diabetes
Prevention of accidents and falls

28. Fostering family relationship and family support
Strengthening of traditional value
Promotion of family relationship
Housing policy to enable family support of older generations
Support of family carers

29. Enhancing community support
Neighbourhood support
Day services
Home care services
Community nursing services
Respite services
Rehabilitation support
Medical care

30. Carer support Identification of informal carers in the community
Provide training and education
Provide material support to carers
Psychosocial support to the carers
Respite care for needs of the carer

31. Ageing Impact in China

32. ADL dependence in older people in China in 2000 (%)
Sex
85+
Total
2.8
4.3
6.6
10.5
18.1
31.3
Male
2.5
5.6
9.7
13.3
29.4
Female
3.3
4.2
7.7
11.3
22.0
32.6

33. 2000-2100 Ageing Trend for≥60 (in 100 million)
4.60
(2052)
3.81
(2100)

34. 2000-2100 population trend for ≥80 (in 10,000)

35. Mode of Delivery Balance of institutional care against community care
Innovation
Advancing technology and knowledge
Diversification of services

36. Analysis on the impact of surge in elder care to public finance of Hong Kong1

37. Future Trend in Ageing Population
Year
65-69
70-74
75-79
80-84
85+
65+
13-14
326,600
212,100
209,900
164,400
150,600
1,063,600
14-15
364,600
214,900
166,000
160,000
1,115,400
15-16
397,500
222,900
206,900
167,300
170,200
1,164,800
16-17
414,800
251,800
198,900
170,600
178,500
1,214,600
17-18
429,900
282,200
193,000
172,700
187,700
1,265,500
18-19
447,500
313,000
192,900
173,200
196,800
1,323,400
19-20
461,900
349,800
196,200
173,700
203,000
1,384,600
20-21
483,300
381,400
204,500
171,900
209,700
1,450,800
21-22
507,600
398,800
232,000
165,600
216,400
1,520,400
22-23
535,500
413,800
260,800
161,400
223,000
1,594,500
23-24
556,500
430,900
290,200
162,200
228,300
1,668,100
24-25
576,100
445,100
324,500
231,400
1,743,100 3

38. 4

39. The Need of Long Term Care9

40. OECD country Institution Rate
Average rate 1.
Korea
0.92% 2.
Italy
1.53% 3.
Poland
1.74% 4.
Czech
1.97% 5.
Denmark
2.20% 6.
Japan
2.64% 7.
France
4.17% 8. US
4.29% 9.
Ireland
4.53% 10
Australia
4.75%
11.
Hungary
4.84%
12.
Finland
5.55%
13.
Belgium
7.01%
14. UK
5.56%
15.
Iceland
6.03%
16.
Norway
6.45%
17.
Netherland
7.23% 18
Switzerland
7.31%
Average
4.4%
Median
4.6%
( ) 10

41. Macao Long Term Care Study
Age Group
(A)
Care Need*
(B)
2006 population
(C)
Resident in aged homes
(D)
Non-user
(B)-(C)
(E)
Need in community
(A)×(D)
(F)
Existing user and those in need
(C)+(E)
(G)
Estimated need
(F)÷(B)×100%
60-64
0.5%
14,400 32
14,368 72
104
0.7%
65-69
1.9%
9,900 35
9,865
187
222
2.2%
70-74
2.0%
9,400 49
9,351
236
2.5%
75-79
4.7%
7,400
100
7,300
343
443
6.0%
80-84
8.6%
4,700
133
4,567
393
526
11.2%
85+
26.0%
4,000
326
3,674
955
1,281
32.0%
65+
5.6%
35,400
643
34,757
1,946
2,589
7.3% 11

42. The Need of Long Term Care Institution in Hong Kong
Year
65+
All Govt. funded residential places
Subsidized bed per population
Waiting list number
Number in govt places+ waiting list
Percentage in need
2007
852,796
21,340
2.60%
22,254
43,591
5.11%
2008
872,200
22,835
2.61%
24,229
47,064
5.39%
2009
882,700
23,082
2.64%
25,526
48,608
5.50%
2010
893,400
23,611
2.67%
26,467
50,078
5.60%
2011
912,100
24,394
2.68%
27,654
52,048
5.70%
2012
941,400
25,287
2.65%
26,763
52,050
5.52%
2013
977,900
25,925
28,818
54,743
5.59% 12

43. Planning for Residential Care in Macao (3.4%)
Year
2011
2016
2021
2026
(a) Age over 65
45,100
63,700
93,300
128,600
(b) Estimated need
2.9%
3.4%
(c) Existing places*／projected requirement
(c) = (a) x (b)
1,330*
2,166
3,172
4,372
private homes places
(2021, 2026 – 20% market share)
505
634
874
Subsidized places
(e) = (c) – (d)
825
1,661
2,538
3,498 13
*1330 – existing number of beds

44. How to plan for the future needs in residential care
Use existing provision by government – 2.6%
China Planning Ratio %
Macao Planning Ratio – 3.4%
OECD Median – 4.6%
Existing Need – 5.5% 14

45. The possible supply for Residential Care Places based on different ratio of provision年份
65+
2.6%
3.4%
4.6%
5.5%
13-14
1,063,600
27,653
36,162
48,925
58,498
14-15
1,115,400
29,000
37,923
51,308
61,347
15-16
1,164,800
30,284
39,603
53,591
64,064
16-17
1,214,600
31,579
41,296
55,871
66,803
17-18
1,265,500
32,903
43,027
58,213
69,602
18-19
1,323,400
34,408
44,995
60,876
72,787
19-20
1,384,600
35,999
47,076
63,691
76,153
20-21
1,450,800
37,720
49,327
66,736
79,794
21-22
1,520,400
39,530
51,693
69,938
83,622
22-23
1,594,500
41,457
54,213
73,347
87,697
23-24
1,668,100
43,370
56,715
76,732
91,745
24-25
1,743,100
45,320
59,265
80,182
95,870 15

46. The need for additional places in residential care
Year
Existing places
2.6%
Additional b eds
3.4%
Additional beds
4.6%
5.5%
Additional Beds
13-14
25,925
27,653
1,728
36,162
10,237
48,925
23,000
58,498
32,573
14-15
29,000
3,075
37,923
11,998
51,308
25,383
61,347
35,422
15-16
30,284
4,359
39,603
13,678
53,591
27,666
64,064
38,139
16-17
31,579
5,654
41,296
15,371
55,871
29,946
66,803
40,878
17-18
32,903
6,978
43,027
17,102
58,213
32,288
69,602
43,677 16

47. Additional Annual Resources in coping with the demand on residential care in per bed/month
Existing provision percentage – 2.6%
6,978 place, + HK$1,088,568,000 (1billion)
Total 32,903 places (HK$5,132,868, billion)
Macao Reference rate – 3.4%
17,102 places, + HK$2,667,912,000 (2.6billion)
Total 43,027 places (HK$6,712,212, billion)
OECD Median – 4.6%
– 32,288 places, + HK$5,036,928,000(5.0billion)
Total 58,213 places (HK$9,081,228, billion)
Fulfill existing need – 5.5%
43,677 places, HK$6,813,612,000(6.8billion)
Total 69,602 places (HK$10,857,912, billion) 17

48. Implication to public policy on aged care
The Need to review in the provision of residential care for older people in Hong Kong
Importance of providing alternative solution to institutional care to satisfy the needs and reduce the demand on institutional care
Explore the possibility of co-payment in reducing public financing burden
Introduction of means test mechanism for users of residential care 18

49. Financing of long term care
Increasing reliance of state support
Rising age dependency ratio
High cost in the provision of institutional long term care services
Unable to rely simply on a tax based system

50. Options for long term care financing
Own savings / out of pocket
Insurance - private
Insurance - with public contribution or intervention
Tax based financing
Part of Medical insurance

51. Delivery of long term care
Proper planning and policy on long term care
Mode of delivery of long term care
Assessment of need of long term care
Manpower issues
Quality issues

52. Planning and public policy on long term care
Assessing the need of the population on long term care through disease surveillance and disability monitoring
Identification of those in need of long term care
Setting the priority in the care provision

53. Possible longer term solution
Publicly funded places only reserve to those older people who are financially disadvantaged
Encourage development of high quality residential care homes to cater for those older people or family with financial means
Establish Long Term Care Insurance or Superannuation Scheme to cover the cost of Long Term Care for those who could afford to pay for their own care 19

54. Thank you 20