In Hong Kong, assisted-living facilities, referred to by the government as residential care homes, are available for those 65 or over (or starting at the age of 60, if a need is proven).
Overview The territory's Social Welfare Department administers a licensing regime to regulate residential care homes, under the Residential Care Homes (Elderly Persons) Ordinance, which was enacted in 1995. According to the SWD, the territory's residential care services for elders have, among other purposes and objectives, an aim to provide residential care and facilities to those who are not able to live at home, due to person, social, health, or other reasons.
History The provision of residential care services began in the early 1960s.The Hong Kong Council of Social Service. (2015). The History of Hong Kong Residential Care Homes for the Elderly. Retrieved from http://webcontent.hkcss.org.hk/el/ [Chinese Version Only] Religious organizations established retirement homes, providing limited residential care services philanthropically. Non-profit organizations also began to offer similar services in the end of the decade. Believing that taking care of the elderly is the responsibility of each family, the government initially only provided financial support to the elderly.
In 1972, the government set up a committee to find out the elderly needs in Hong Kong. The report released by the committee helped foster the later development of the residential care homes for the elderly. Among all the suggestions by the committee, the concept of "community support" is still being adopted nowadays.
Lacking government subsidized residential facilities for the elderly, numerous private residential facilities were established during the mid-1980s, but the quality of these private facilities was often unsatisfactory. In 1994, the Legislative Council of Hong Kong passed the Residential Care Homes (Elderly Persons) Ordinance. All residential care facilities (except nursing home, which is monitored by the Hospitals, Nursing Homes, and Maternity Homes Registration Ordinance) must be licensed to legitimate their operation under the ordinance. The ordinance was officially implemented in 1996, and the licensing office of the Social Welfare Department was responsible for its enactment.Qualification Framework, The Government of the Hong Kong Special Administration Region. (2014). Elderly Care Service: Specification of Competencies Standards. Retrieved from http://www.hkag.org/rpl/PDF/ECS%20SCS%201st%20version%202014_12_chi_ALL.pdf [Chinese Version Only]
To further solve the problem of insufficient subsidized residential facilities, the government initiated Bought Place Scheme in 1989 and Enhanced Bought Place Scheme in 1999 to purchase places in private residential facilities.
During the 1990s, the government conducted another research on the needs of the elderly. The research report concluded that residential care services should primarily be provided to those with more disabilities and that the government should, therefore, set up stricter rules for enrollment and transform all Homes for the Aged to Care and Attention Homes for the Elderly and Nursing Homes. Since then, the focus of residential care services has been to predominantly take care of those with moderate or severe level of disabilities.
In 2001, the government introduced competitive bidding as the new mode of selecting operators in delivering care services in her residential facilities (i.e., contract homes) to enhance the efficiency of her residential care services and reduce the operational costs in these facilities.
With the "ageing in place" as the government's guiding principle in providing residential care services, the government now predominantly focuses on developing Care and Attention Homes for the Elderly and Nursing Homes. From 2003 and onwards, the government no longer accepts new applications to Hostel for the Elderly and Home for the Aged. In later years, the government also gradually transformed these two types of residential facilities and those that are not providing long-term nursing support to places that deliver continuum support and intensive nursing care.
Current situation in Hong Kong
Types There are several types of residential care homes for elderly persons in Hong Kong.Social Welfare Department.(2005). Residential Care Services For Elderly. Retrieved from http://www.swd.gov.hk/doc/elderly/(P13).pdf
Types Service provided Target elders characteristics Hostel for the Elderly Communal living accommodation, programme activities, 24hour staff support Capable of self-care Home for the Aged Residential care, meals, limited degree of assistance in daily activities Unable to live independently in community Not yet dependent on assistance with person/nursing care No or mild impairment level under Standardised Care Need Assessment Mechanism for Elderly Service (SCNAMES) Care and Attention Home for the Elderly Residential care, meals, limited nursing care Suffer from poor health and/or physical/ mild mental disabilities with deficiency in daily living activities But mentally suitable for communal living Moderate level under SCNAMES Nursing Home Residential care, meals, personal care, regular basic medical and nursing care Suffer from poor health and/or physical/ mild mental disabilities with deficiency in daily living activities But mentally suitable for communal living Severe level under SCHNAMES Those who cannot adequately be taken care of in Care and Attention Homes for the Elderly
Number of places The number of places in residential care homes for elderly persons (as of 30 September 2017) is as follows:Social Welfare Department. (2017). Overview of Residential Care Services for the Elderly. Retrieved from http://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_residentia/id_overviewon/===
Types of Residential Care Services for the Elderly Subsidized Places in Subverted Homes, Self-Financing Homes and Contract Home Subsidized Places Under Enhanced Brought Place Scheme Non-Subsidized Places in non-profit-Making Self-Financing Homes / Contract Homes Total Hostels or the Elderly 0 0 0 0 Homes or the Aged 67 0 445 512 Care and Attention Homes for the Elderly 15229 8601 3093 26383 Nursing Homes 3904 0 1517 5421 Total 19200 8061 5055 32316
Regulation and monitoring
The Residential Care Homes (Elderly Persons) Ordinance
The Residential Care Homes (Elderly Persons) Ordinance (RCHE Ordinance), administered by the Director of Social Welfare (DSW) is responsible for licensing and regulating of Residential Care Homes for Elderly Persons (RCHE). The Ordinance aims to ensure residents in RCHE will receive acceptable quality of services that are beneficial to them physically, mentally and socially.Legislative Council (26 May 2014). Regulation of Private Residential Care Homes for Elderly and for Persons with Disabilities and Relevant Measures, p. 2. Retrieved from http://www.legco.gov.hk/yr13-14/english/panels/ltcp/papers/ltcp0526cb2-1558-1-e.pdf
The Code of Practice for Residential Care Homes (Elderly Persons)
The Code of Practice for Residential Care Homes (Elderly Persons) (Code of Practice) provides RCHEs with principles, procedures, guidelines and standards to comply in operation and management. The details in Code of Practice includes requirements in relation to license, such as infection control, floor space, cleanliness and sanitation, social care, etc.Social Welfare Department (March 2013). Code of Practice For Residential Care Homes (Elderly Persons). Retrieved from http://www.swd.gov.hk/doc/LORCHE/CodeofPractice_E_201303_201503R5.pdf Social Welfare Department will update and review the Code of Practice from time to time when new and additional needs arise for RCHE residents.
Supervisory and inspection arrangement
Under the RCHE Ordinance, DSW supervises RCHEs through regular inspections, providing remedial measures and requiring below-standard RCHEs to cease operations in cases of danger/perceived danger or unfulfilled requirements. In particular, DSW will inspect RCHEs in accordance to section 18 of RCHE Ordinance, covering comprehensive areas such as drug management, personal care services, handling of accidents, meals, etc.
Professional inspectorate in LORCHE under Social Welfare Department will be responsible for inspection, as well as cooperate with staff from Buildings Department and the Fire Services Department. On average, LORCHE conducts seven surprise inspections at each private RCHE annually. In addition, audit checks of RCHEs are also conducted by Senior Social Work Officer.Legislative Council (23 July 2015). Issues relating to Service Quality and Monitoring of Private Residential Care Homes, p. 6. Retrieved from http://www.legco.gov.hk/yr14-15/english/panels/ws/papers/ws20150723cb2-1906-2-e.pdf
Upon detecting irregularities during inspection, RCHEs are required to rectify them. Advisory or warning letters will first be issued to non-compliant RCHEs, and prosecutions may be undertaken when necessary. RCHEs that have been convicted in the recent 24 months would be recorded and notified to the public.Social Welfare Department. Record of Residential Care Homes for the Elderly Convicted in the Recent 24 Months. Retrieved from http://www.swd.gov.hk/en/index/site_pubsvc/page_lr/sub_rche/id_records/
The total number of significant incident reports submitted by RCHEs to the Social Welfare Department in the past 3 years:Legislative Council (2017). Written replies from Secretary for Labour and Welfare on Service for The Elderly LWB(WW)0056. Retrieved from http://www.legco.gov.hk/yr16-17/english/fc/fc/w_q/lwb-ww-e.pdf
Type of RCHEs 2014–15 2015–16 2016–17 (Up to end-December 2016) Private RCHEs 230 238 178 Subvented RCHEs/ contract homes 71 72 57 Self-financing RCHEs 5 5 8
Significant incidents refer to uncommon deaths or incidents resulting in serious injuries or deaths, missing of residents that require police assistance, suspected or established cases of abuse of residents by staff, disputes requiring police assistance, serious medical incidents and other major incidents that would affect the daily operation of the RCHEs for at least 24 hours, etc.
Challenges and issues
Cambridge Nursing Home controversy
On 26 May 2015, Ming Pao reported that elderly residents of the Cambridge Nursing Home in Tai Po who suffered from impairment in self-care ability were stripped naked by staff members on an open-air podium, before being wheeled indoors to shower.Ming Pao. (26 May 2015). 長者遭脫光露天等冲涼. Retrieved from: https://news.mingpao.com/pns/%E9%95%B7%E8%80%85%E9%81%AD%E8%84%AB%E5%85%89%E9%9C%B2%E5%A4%A9%E7%AD%89%E5%86%B2%E6%B6%BC-%E8%AD%B7%E8%80%81%E9%99%A2%E5%89%B5%E8%BE%A6%E4%BA%BA%E8%AA%8D%E6%90%8D%E5%B0%8A%E5%9A%B4%20%E7%A4%BE%E7%BD%B2%E6%A5%B5%E5%BA%A6%E9%97%9C%E6%B3%A8/web_tc/article/20150526/s00001/1432577551357 Reports revealed that the Social Welfare Department issued 15 warnings to the Nursing Home in the past 5 years, but failed to make any prosecutions.Ming Pao. (26 May 2015). 涉事院舍 社署巡百次零檢. Retrieved from: https://news.mingpao.com/pns/%E6%B6%89%E4%BA%8B%E9%99%A2%E8%88%8D%20%20%E7%A4%BE%E7%BD%B2%E5%B7%A1%E7%99%BE%E6%AC%A1%E9%9B%B6%E6%AA%A2%E6%8E%A7-5%E5%B9%B4%E6%8E%A512%E6%8A%95%E8%A8%B4%20%20%E6%A5%AD%E7%95%8C%E8%BD%9F%E7%9B%A3%E7%AE%A1%E7%84%A1%E7%94%A8/web_tc/article/20150526/s00001/1432577557487
On the same day, the Social Welfare Department referred the case to the Tai Po district crime squad for investigation.Stand News. (26 May 2015). 安排老人露天裸體 大埔劍橋炒員工兼道歉 重案組、社署調查. Retrieved from: https://www.thestandnews.com/society/%E7%84%A1%E8%89%AF%E8%AD%B7%E8%80%81%E9%99%A2-%E5%AE%89%E6%8E%92%E8%80%81%E4%BA%BA%E9%9C%B2%E5%A4%A9%E8%A3%B8%E9%AB%94-%E5%A4%A7%E5%9F%94%E5%8A%8D%E6%A9%8B%E7%82%92%E5%93%A1%E5%B7%A5%E5%85%BC%E9%81%93%E6%AD%89-%E9%87%8D%E6%A1%88%E7%B5%84-%E7%A4%BE%E7%BD%B2%E8%AA%BF%E6%9F%A5/