For discussion FCR(96-97)66
on 1 November 1996

ITEM FOR FINANCE COMMITTEE

CAPITAL WORKS RESERVE FUND
HEAD 710 - COMPUTERISATION
Health and Welfare Branch
New Subhead "Residential Care Services Delivery System for the Elderly"
HEAD 47 - INFORMATION TECHNOLOGY SERVICES DEPARTMENT
Subhead 001 Salaries

Members are invited to approve -

1. a commitment of $12,803,000 in a new subhead "Residential Care Services Delivery System for the Elderly" under Head 710 Computerisation; and
2. an increase in the ceiling placed on the total notional annual mid-point salary value of all non-directorate posts in the permanent establishment of the Information Technology Services Department in 1996-97 from $307,147,960 by $1,010,040 to $308,158,000 for creating additional non-directorate posts to develop, establish and implement the system.

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PROBLEM
PROPOSAL
JUSTIFICATION
FINANCIAL IMPLICATIONS

Non-recurrent cost
Recurrent cost
Implementation Plan
BACKGROUND INFORMATION

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PROBLEM

There is a need to set up a new integrated computer system to improve waitlisting of applications and processing of placements for all types of residential care institutions (RCIs) for the elderly¹.

PROPOSAL

2. The Secretary for Health and Welfare (SHW), on the advice of the Director of Information Technology Services, proposes -

1. to create a commitment of $12,803,000 to implement the proposed Residential Care Services Delivery System for the Elderly in order to establish a computerised, integrated waiting list of the elderly applying for admission to all types of RCIs; and
2. to increase the ceiling placed on the total notional annual mid-point salary value of all non-directorate posts in the permanent establishment of the Information Technology Services Department (ITSD) in 1996-97 from $307,147,960 by $1,010,040 to $308,158,000 for creating additional non-directorate posts to develop, establish and implement the system.

JUSTIFICATION

3. The Social Welfare Department (SWD) and the Hospital Authority (HA), which are responsible for providing residential care services to meet different needs of the elderly, maintain independent waiting lists with stand-alone micro-computers. The SWD’s waiting list covers applications for self-care hostels, homes for the aged and care-and-attention homes while the HA’s waiting list covers applications for infirmaries. As at 30 September 1996, there were 141 institutions under the SWD waiting list and 13 infirmaries under the HA waiting list, providing 15 840 places and 620 beds respectively. At the same time, there were 22 850 applicants on the SWD waiting list and 5 400 on the HA waiting list.

4. The Governor in his 1993 Policy Address pledged to introduce nursing homes, a new form of residential care, in order to provide an intermediary type of service between infirmaries and care-and-attention homes. The Director of Health is establishing six nursing homes with a total provision of 1 400 beds, with the first one commencing operation in late 1997. The new nursing homes will form part of the continuum of residential care services provided for the elderly.

5. Given the large number of applications involved, it is necessary to develop a integrated computerised waitlisting system to bring together information on all types of residential care services so that we can conduct waitlisting of applicants and arrangement of placements for the RCIs in a fair and efficient manner. The SWD, HA, and the Department of Health (DH) will operate the proposed computer system under the monitoring of the Elderly Services Division of Health and Welfare Branch (HWB). The objectives of the proposed system are to -

1. integrate all applications for admission to infirmaries, nursing homes, care-and-attention homes, homes for the aged and self-care hostels into one single waiting list;
2. facilitate transfer of applicants from one level of residential care to another level of care, as necessary, due to changes in their health conditions;
3. centralise applicant information and eliminate duplication of applications to facilitate easy retrieval of information, reduce staff efforts in collecting, processing and maintaining applicant information, and reduce inaccuracy;
4. reduce the tedious manual operations resulting from the limitations of the existing independent waiting lists;
5. overcome the limitations of the existing computer systems in SWD and HA by including additional data fields and system functions into the proposed system; and
6. facilitate exchange and transfer of management information between HWB, SWD, HA and DH for planning and monitoring purposes.

6. The major functions of the proposed computer system include data collection and processing for -

application registration;
assessment results;
placement;
case closure;
monitoring of arbitration cases;
dealing with applicants requiring a different level of care due to a change in their health conditions;
placement for the Bought Place Scheme;
priority placement;
special arrangement for admission to designated homes; and
management statistics compilation.

7. While the proposed system would achieve cost avoidance of less than $1 million, it will bring about significant intangible benefits through better service to the elderly, better use of resources and increased efficiency. Specifically, the benefits of the system are -

(a) To improve the handling of applications and enquiries

SWD and HA now maintain separate waiting lists with standalone micro-computers which do not allow direct exchange of information between the two lists. It is therefore difficult to check if an elderly person has registered on both waiting lists. In addition, it is a waste of staff efforts to collect, process and maintain duplicated applications and information.

The establishment of the integrated waiting list will better coordinate the processing of applications for residential care service. It will save the applicants’ as well as their families’ time and efforts in applying for an appropriate level of care through a single point of application. It will also save staff efforts in handling duplicated applications and information.

(b) To better meet the elderly’s choice of residential care homes and to reduce the need for re-assessments of applicants

On the basis of projected vacancies done manually for an individual institution, SWD generates a suitable number of cases in accordance with the stated preferences of the applicants from the waiting list by the existing micro-computer system. Those shortlisted applicants will undergo a medical check and then wait for a placement in the preferred institutions. Under the current system, we allow each applicant to wait for only one home and will not consider him (or she as the case may be) for another home which may also suit his preference. Whether he can get a placement in his preferred institution depends on when the anticipated vacancy materialises. It is possible that some shortlisted applicants may have to wait for a longer time if only a very small number of vacancies eventually come up in the preferred home they apply for. In some extreme cases, the shortlisted applicants may need to undergo a re-assessment of their medical conditions as the validity of one year of the previous medical examination expires.

The proposed computerised system will take in all preferences of the applicants and allow them to wait for all the homes that suit their preferences simultaneously. The system will facilitate more accurate and fair matching of applicants for residential care services and will speed up the placement process. Moreover, the new computer system can give a more accurate prediction of vacancies, thus reducing the need for re-assessment of applicants after expiry of their previous medical examination results.

(c) To enhance efficiency in arranging special placements

The existing systems in SWD and HA have limited scope. In SWD, we have to manually match placements with applications for RCIs with special characteristics such as the absence of lift, managing the small pool of the elderly shortlisted for admission, and maintaining the waiting list for matching applications with placements in Bought Place Scheme. In HA, the present system only maintains one list for all infirmary applications. Manual efforts are required to keep and update a separate list for priority applications. The proposed system would computerise the above functions and thus enhance efficiency in dealing with special placements.

(d) To facilitate better planning and service evaluation

Since applications can join either the SWD or the HA queues under the current systems, SHW is not able to have an overall perspective on the needs of the elderly for different residential care facilities for better planning and monitoring of the provision of such services to the elderly in need. Moreover, since the SWD and HA use the micro-computers also for other operations, it may take applicants up to one day or more to obtain the most up-to-date progress of their applications. Furthermore, the current database do not keep some essential data. For example, in SWD, the electronic record do not store applicants’ addresses, while in HA, the data base do not show that applicants have refused immediate admission. Staff have to resort to file records to retrieve such information in case of need.

The new system would allow concurrent access by multiple users, thus facilitating timely updating of information like changes in applicant’s preference and health status, assessment findings and outcome of referral for placement. Besides, the system is able to generate regular management statistics on applicants’ profile, demand for and supply of services, and utilization of resources. All those will help to facilitate better planning and evaluation of the residential care delivery services for the elderly. In addition, the establishment of the new system will reduce the response time to enquiries by both organisations concerned and the applicants regarding the progress of their applications.

FINANCIAL IMPLICATIONS

Non-recurrent cost

8. We estimate that the total non-recurrent cost of the proposed system is $14,330,000, broken down as follows -

9. As regards paragraph 8(a), the cost of $3,120,000 is for the acquisition of computer hardware including database servers, file servers, workstations, peripherals and data communication equipment and system software.

10. As regards paragraph 8(b), the cost of $7,641,000 is for implementation, system development, data conversion and technical support services.

11. As regards paragraph 8(c), the cost of $757,000 is for site preparation work including the installation of conduit facilities and power points for computer equipment.

12. As regards paragraph 8(d), the cost of $121,000 is for setting up of communication line at HWB, SWD, DH, HA and ITSD sites, acquisition of initial consumables and miscellaneous items required during implementation.

13. As regards paragraph 8(e), the sum of $1,164,000 is for contingencies.

14. As regards paragraph 8(f), the cost of $1,527,000 represents ITSD’s full staff costs of three man-months of Senior Systems Manager ($378,000), 5.8 man-months of Systems Manager ($466,000) and 13.2 man-months of Analyst/ Programmer I ($683,000) required for the management of the implementation project. This requires the creation of one Systems Manager post and one Analyst/ Programmer I post in 1996-97 and an increase in the total notional annual mid-point salary value of ITSD from $307,147,960 by $1,010,040 to $308,158,000 for 1996-97. The user departments/organisation, including HWB, SWD, DH and HA, will absorb the additional staff costs required for the development and implementation of the system.

Recurrent cost

15. The estimated additional annual recurrent cost of maintaining and supporting the new system after implementation is $3,206,000 for the first four years and $3,372,000 thereafter. The breakdown is as follows -

16. As regards paragraph 15(a), the cost of $1,007,000 is for hiring service to perform on-going system maintenance and support.

17. As regards paragraph 15(b), the cost of $292,000 is for the maintenance of computer hardware and software. The existing terms and conditions of the computer bulk contract allow a special discount for the maintenance service charge of some equipment for the first four years. There will be an increase of $166,000 in the maintenance cost from the fifth year onwards.

18. As regards paragraph 15(c), the cost of $255,000 is for the rental of communication lines connecting HWB, SWD, DH, HA and ITSD sites and consumables such as toner and paper for laser printers, and disks and tapes for backup.

19. As regards paragraph 15(d), the cost of $1,288,000 is the full staff cost of 5.1 man-months of Systems Manager ($406,000), 12.1 man-months of Analyst/Programmer I ($629,000) and 8.5 man-months of Computer Operator I ($253,000) required by ITSD for system management and day to day system support.

20. As regards paragraph 15(e), the cost of $364,000 represents the full staff cost of two additional Clerical Assistants required by SWD to maintain the system. Staff costs of HWB, DH and HA are to be absorbed by respective departments.

Implementation Plan

21. We plan to implement the proposed system in two phases. Phase 1 mainly covers the basic waiting list functions and Phase 2 covers the development of the other supplementary functions such as special arrangement, placement for Bought Place Scheme and management statistics reports.

22. The proposed implementation timetable is as follows -

BACKGROUND INFORMATION

23. The Working Group on Care for the Elderly completed a review of elderly services in 1994 and recommended, inter alia, to establish a computerised integrated waiting list in order to improve the efficiency, quality and cost-effectiveness of the residential care services delivery system. In April 1995, ITSD conducted a Request Justification Study to review existing waiting list systems and assess the viability of the integrated list. The study findings demonstrated that there was a prima facie case for computerisation. The Feasibility Study subsequently showed that it was technically feasible to implement the proposed system and there was a pressing need to streamline the current application procedures for residential care services and to provide regular management information for better decision making and planning.

24. The original proposal of the Working Group on Care for the Elderly was to establish a computer network to link up all residential institutions for the elderly in addition to the integrated waiting list. In view of the complexity of the computer linkage with all residential care institutions, SHW has decided to consider the justifications for, and feasibility of the full network in the light of experience gained in operating the computerized waiting list.

Health and Welfare Branch
October 1996

¹ Residential care institutions include self-care hostels, homes for the aged, care-and-attention homes, nursing homes, and infirmaries.

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