For discussion
on 10 November 1997
Provisional Legislative Council
Panel on Health Services
Elderly Health Centres : A Review
and The Way Forward
PURPOSE
The purpose of this paper is to provide an account of the services provided by the Department of Health's elderly health centres and to inform members of proposed changes to the scope and delivery of services.
BACKGROUND
2.On the basis of the recommendations of the Working Party on Primary Health Care , seven elderly health centres were established between 1994 and 1997 in Sham Shui Po, Kwun Tong, Shau Kei Wan, Kennedy Town, Yuen Chau Kok, Shek Wu Hui, and Tsuen Wan to provide preventive and promotive health services for elderly people.
ACITIVITIES
3.The elderly health service aims to promote health and well being of elderly persons living in the community through enhancing their knowledge of healthy lifestyle and self-care, screening for common health risks and diseases, and promoting community participation in health care.
4.The number of clients enrolled in the service between May 1994 and September 1997 is as follows -
Year| Enrollment
| |
| 1994 | 718
|
| 1995 | 2 031
|
| 1996 | 4 068
|
| 1997(Jan-Sept) | 6 109
|
5.Clients are charged an annual enrollment fee of $220. Of those who enrolled, about a third continued to join the service in the following year.
6.Community and centre-based health promotion activities are organized to enrich the elderly's knowledge of their own health and enhance their ability to adopt a healthy lifestyle and practise self-care. These include health talks, behaviour modification workshops and support groups, etc. To date, over 300 000 attendances by elderly people at various health promotion activities have been recorded. Among those who participated in behaviour modification programmes, for instance, 28% of regular smokers and 58% of elderly without physical exercise managed to adopt a more healthy lifestyle. Nonetheless, continuous reinforcement was considered necessary in sustaining behavioral changes.
7.The elderly health centres offer complete physical check-up with baseline blood and urine testing on a routine basis, and laboratory investigations such as x-ray examination, special blood testing, cervical smear or electrocardiograph for patients with specific risk factors . Among 4 068 enrollees in 1996, 251 (23%) cases of cataract, 59 (5%) cases of hypertension, 43 (4%) cases of diabetes, 32 (3%) cases of depression and 4 (0.4%) cancer cases were newly detected. Affected individuals were referred for treatment in clinics in private or public sectors. Information on health problems formed the basis for future planning and implementation of health promotion programmes.
8.In enhancing community participation, collaborative efforts were made to support health promotion activities undertaken by relevant parties. For example, 99 clients continued to disseminate health messages in their own circles after successfully completing the Senior Health Ambassador Programme run by the Department's Central Health Education Unit.
9.A Clients' Satisfaction Survey revealed that over 90% of existing clients considered the overall performance of the elderly health centres " good " or " very good " . Health screening was considered to be the most attractive part of the programme.
REVIEW RESULTS
10.Despite efforts to recruit new members, enrollment rate at the health centres remained low for some time and was slow to take off. A Service Needs Assessment Survey found that although 44% of the 528 interviewees who patronized social centres for the elderly said they would be interested to join the elderly health centres, actual enrollment with the health centres was low. The unfavorable take-up rate could have been attributed to one or more of the following factors -
- inconvenient locations for some users;
- common occurrence of health problems among the elderly population making primary prevention less attractive than curative services;
- lack of curative and other paramedical services is not conducive to assuring comprehensiveness and continuity of care; and
- the annual enrollment fee of $220 could be a financial burden to some elderly people.
WAY FORWARD
11.Experience gained from operating the elderly health centres since 1994 has enabled the Department of Health to map out a new strategy on the provision of primary integrated health services to the elderly community. The Department plays an important part in helping older members of the community age in place, and for them to do so with dignity, self-reliance and maximal independence. To enhance primary health care to elderly people living in the community, improve their self-care ability, encourage healthy living and strengthen family support so as to minimize illness and disability, the Chief Executive announced in his Policy Address on 8 October 1997 the establishment of 12 elderly health centres (including the existing seven centres) and 12 visiting health teams in 1998-1999 and another six centres and six teams in 1999-2000. A comprehensive and more effective primary health care programme encompassing health education, support services and curative treatment will be provided.
SERVICE SCOPE
12.The new integrated elderly health service aims to provide primary preventive and promotive health care services to elderly people through activities undertaken by the elderly health centres and visiting health teams.
13.Apart from strengthening preventive and promotive services such as health education and screening offered in existing elderly health centres, the centres under planning will provide, in addition, curative care from a family medicine perspective using a multi-disciplinary team approach with the support of paramedical staff such as dietitians, clinical psychologists, physiotherapists and occupational therapists. An integrated multidiscipinary care model is considered more relevant to addressing the multi-dimensional needs of elderly people. The new centres will provide an alternative service option for older members of the community. This will also go some way to easing the demand for general out-patient service.
14.The visiting health teams will reach beyond the confines of the health centres into the community and residential care settings. Through health education, support services to carers and various health-related programmes by means of the " train the helper/carer approach " , the teams aim to achieve wide dissemination of knowledge on elderly health and health care. Improved self-care and support from carers will, in the long run, enable elderly people to age in place. For instance, staff employed in social centres, elderly homes and home help service will be equipped with the necessary knowledge and skill in taking care of old people in the community. The level of support rendered by the visiting health teams will vary depending on individual circumstances.
PHYSICAL PLANNING
15.To observe closely the time schedule as pledged, majority of centres will initially be developed inside or in close proximity to general out-patient clinics. Where possible, purpose-built regional centres will be built to make available adequate accommodation for clients and staff. It is expected that some of the centres will commence operation in the first half of 1998-1999, to be followed by opening of the remaining centres in phases.
FEES
16.The fees structure and level of charging will be reviewed, taking into consideration clients' ability to pay.
ADVICE SOUGHT
17.Members are requested to note and comment on the content of the paper.
Department of Health
November 97
