Panel on Welfare Services Meeting on 25 January 1999
Services for Demented Elderly
We informed the LegCo Panel on Welfare Services on welfare services for demented elderly on 13 June 1997. This paper serves to inform Members of our proposal to provide dedicated service units in residential care homes and day care centres for demented elderly.
Dementia and Its Care Needs
2. Dementia is a disease characterised by gradual decline in intellectual function which occurs in clear consciousness.
3. The typical clinical course in dementia is progressive decline in mental function, leading to total dependence on others and requiring multiple levels of services. The average survival is 8-10 years. The clinical course of the disease can be divided into a number of stages, ranging from mild memory impairment, subtle personality changes to deterioration in self-control, loss of orientation, delusions, behavioural problems and eventually may become bed-bound.
4. Since dementia is a complex problem, a community-based multi-disciplinary approach is essential in the care of dementia. Services include medical, social, voluntary and legal. Medical service comprise outpatient service, domiciliary care, outreach service to aged homes and day care centres, day hospital, inpatient unit and long-term care. Social services include financial help, home help, day care centres, multi-service centres for the elderly, residential and respite services.
Pilot projects on Dedicated Services for the Demented
5. With an ageing population, the number of persons suffering from dementia is likely to increase. To cater for the special needs of elderly with dementia, the Social Welfare Department will be conducting pilot schemes to set up dementia units in subvented residential care homes and day care centres to provide dedicated services for the demented in 1999-2000. Stand-alone residential care homes and day care centres for demented are not recommended to avoid stigmatisation.
6. The objectives of these dementia units are to provide dedicated specific care services for the demented in either residential or day care settings. They provide tailor-made training to enhance the functioning and independence of the demented as well as provide support and relief to care-givers.
7. Specialised programmes and facilities provided to the demented, inter alia, include:
- wandering path - elderly at the mild and moderate stages of dementia tend to exhibit much wandering behaviour. The provision of wandering path in the unit provides a safe environment for them to walk about;
- orientation signs in corridors and rooms - demented elderly usually suffer memory loss and disorientation. It is therefore important to have orientation signs to assist them;
- reminiscence corner - demented persons typically lose their short-term memory first whereas long-term memory can be retained longer. Reminiscence activities can help recall their happy experience and build up self-image;
- memory training and other rehabilitation activities - training will be provided to enhance functioning and independence in daily living activities and defer deterioration;
- padded walls - as demented elderly tend to exhibit wandering behaviour, the provision of padded wall serves to prevent injuries; and
- training and support services for the care-givers are also provided to improve their understanding of the disease and problem-solving approach. Residential respite services are available to relieve care-givers for a few days' break. Care-givers do not often have holidays because of their commitment to care.
9. Five dementia units in subvented residential care homes for the elderly and two day care centres for the demented will be set up under the pilot project. The capacity of each unit in residential care homes is 24-28 clients (including one for respite purpose) and that for day care centre is 20 clients. Based on individuals' conditions, admitted clients would be considered for discharge after receiving training. Referrals for other services will be arranged if necessary. This allows more demented elderly to make use of the service. The pilot project is scheduled to commence in April 1999 for three years with completion in March 2002. In the 3-year period, the Social Welfare Department will conduct mid-term and final evaluations to examine the cost-effectiveness and to consider way forward for these services.
10. A new Dementia Supplement at about $40,000 per elderly per year has been provided to subvented Care & Attention homes since November 1998 to employ additional staff to provide better care for the demented elderly. The provision benefited 200 elderly. Resources for a further 160 demented elderly will be provided in 1999-2000.
11. On top of this, a pilot project on Day Respite Service for the Elderly will be launched in 1999/00 to provide temporary day care to relieve the carers from the regular caring responsibility.
12. A Working Group comprising medical and social work professionals and academics has been set up under the Health and Welfare Bureau to review existing services for the demented and to recommend areas for improvement. The Working Group will submit its Report to the Administration in mid 1999.
Health and Welfare Bureau