1. 1 Love in the Service of Hope CADENZA Symposium 2009 Primary Care & Older Persons – Key to Medical and Social Integration 9 th October 2009 Primary Care for Elderly: The Need for Integrated Medical and Social Care Chan Mei Kit, Maggie Director, Social Work Services Caritas – Hong Kong

2. 2 Love in the Service of Hope

3. 3 Ageing and The Need of Care Service Two possible Developments: 1.First Scenario If aged people have health problem, they will have more years spent in poor health.  Statistics indicate that the utilization rate of health care services rises exponentially for people aged 65 and above.

4. 4 Love in the Service of Hope Source: Strategic Service Plan of Hospital Authority (2009 – 2012)

5. 5 Love in the Service of Hope 2.Second Scenario Increase in life expectancy will be associated with an improvement in the health of the elderly.  Elderly aged between 65 and 75 are still healthy.  The oldest age group (above 75) has difficulties in caring themselves.  The use of care service (especially intensive care service) will be postponed to a later age.

6. 6 Love in the Service of Hope Self-rated Health Proportion (%) Age ExcellentVery GoodGoodFairPoor Unknown/ Missing 75 and above 0.96.527.944.219.51 65 – 74 1.39.924.650.813.30.1 All Persons aged 15 and above 2.7203635.55.70.2 Source: Population Health Survey 2003 - 2004

7. 7 Love in the Service of Hope Extent of Limitation in Accomplishing Moderate Activities Proportion (%) Age No, Not limited at all Yes, limited a little Yes, limited a lot Unknown/ Missing 75 and above39.339.519.71.4 65 – 74 60.031.08.70.3 All Persons aged 15 and above 84.112.63.00.3 Source: Population Health Survey 2003 - 2004

8. 8 Love in the Service of Hope Conclusion 1.Morbidity and the health condition of the elderly are the influencing factors on the demand of care service and the level/intensity of care service. 2.It is important to promote/improve heath condition of the elderly and enhance their ability to live independently.

9. 9 Love in the Service of Hope Conclusion 3.The provision of integrated medical and social care service is essential to support the elderly living in the community. 4.More effort made to develop preventive health care and rehabilitative service will improve health and avoid disabilities of the elderly, thus diminishing the need for hospital care and intensive care service. (Reference: Ageing and Its Consequences for the Socio-medical System Council of Europe, 1995)

10. 10 Love in the Service of Hope Preparation for the Demographic Shift 1.Practitioners of Welfare and Health Sector Effort has been made by NGOs to promote community-based primary care service for the elderly through our networks of ：  Neighbourhood Elderly Centres  District Elderly Community Centres  Enhanced Home and Community Care Service  Other community-based service centres (Caritas)

11. 11 Love in the Service of Hope 2.The Elderly Increase of awareness of the elderly on the need to maintain their health conditions to prepare for positive ageing.

12. 12 Love in the Service of Hope 3.The Community The public is aware of the issue and advocates for a healthy city.

13. 13 Love in the Service of Hope Collaborative Projects 1.Aged Support Community Network and Community Volunteer Service 8 NGOs collaborated with HA (HK West Cluster) 2.Hong Kong East Community Network 7 NGOs collaborated with Eastern Hospital 3.Fall Prevention Project and Education Project on Hepatitis Disease NGOs in Shamshuipo collaborated with CMC

14. 14 Love in the Service of Hope 4.Elderly Suicide Prevention Programme and Psychogeriatric Support Purchased Service NGOs with Castle Peak Hospital 5.Outreach Service for High Risk Elderly and Care Plans for Elderly NGOs collaborated with Tai Po Hospital

15. 15 Love in the Service of Hope 6. Fall Prevention Project Caritas collaborated with the Chinese University to organize the project at 12 Centres 防跌測試

16. 16 Love in the Service of Hope Achievements Through collaboration, we have succeeded in: 1.Providing community based and one stop service in response to the health status and care needs of elderly of different segment with objectives to:

17. 17 Love in the Service of Hope  enable early detection and follow up service  provide preventive and rehabilitation service  provide Integrated and seamless care service for elderly discharged from hospitals

18. 18 Love in the Service of Hope 2.Outreaching to elderly in the community, especially the deprived 義工量血壓

19. 19 Love in the Service of Hope 3.Setting up formal or informal networks among NGOs, SWD, DH and HA to coordinate integrated service in districts:  District Coordinating Committees convened by SWD  Collaborative networks convened by HA Cluster/ NGOs  Some are project-based networks

20. 20 Love in the Service of Hope 4.Promoting elders’ participation and their awareness Empowering the elderly to sustain their health and to provide peer support to promote health education. 跌倒風險測試

21. 21 Love in the Service of Hope 5. Engaging the community Mobilizing support from carers/family, volunteers, community leaders to provide community support.

22. 22 Love in the Service of Hope 6.Strengthening NGO’s service quality for elderly Soliciting support from HA including training of staff, consultation service, advice on infectious disease control, sharing of information and direct referrals. 7.Mobilization of community resources for health programmes Support from District Council, Community Investment and Inclusion Fund, donation and NGOs’ resources have been sought.

23. 23 Love in the Service of Hope Difficulties in Sustaining Collaboration 1.Development of integrated service is piecemeal and fragmented due to lack of long term planning. 2.Rely on the initiatives of the front-line practitioners but without support from policy makers. 3.Formal collaborative networks are lacking in some districts.

24. 24 Love in the Service of Hope 4.Resources provided are on short-term or on project-basis. 5.Insufficient nurses and therapists to provide primary care and rehabilitative service.

25. 25 Love in the Service of Hope Recommendations 1.The need for Long Term Planning for Integrated Care Service The Government should take the lead to formulate a long term plan on integrated care service including primary care service for elderly.

26. 26 Love in the Service of Hope Through the planning process, we can:  conduct needs assessment and project future demand of social and health care services;  develop a community based model to deliver primary care and community care services by engaging NGOs, medical sector, the elderly, carers and the community;

27. 27 Love in the Service of Hope  set up formal networks in districts for service interfacing;  develop strategy on training of medical and health care workers to meet rising demand of services;  identify and allocate resources to implement the recommendations.

28. 28 Love in the Service of Hope 2.The need for Evidence-based Service Planning A database on the population aged 55 and above, including indicators of health, morbidity, socio-economic status, family and household characteristics should be developed to enhance future service planning and review.

29. 29 Love in the Service of Hope 3.The need to adopt information technology to promote primary health care

30. 30 Love in the Service of Hope 4.The need to engage our users and the community in formulating the long term plan It is important to invite our elderly and the community to discuss the long term plan.

31. 31 Love in the Service of Hope 徐祥齡在東莞創辦的橫瀝隔坑社區服務中心 Source: takungpao.com

32. 32 Love in the Service of Hope Thank you