20191103 FYSK Elderly Report Final ENG by 蓬瀛仙館

Report of the Study on the Needs of Elderly Singletons, Elderly Couples and Caregivers for Various Community Support Services in Tai Po and North District

Fung Ying Seen Koon & Policy 21 2019

Published by Fung Ying Seen Koon 66 Pak Wo Road, Fanling, New Territories, Hong Kong.

ISBN: 978-988-77797-2-8

ACKNOWLEDGEMENTS This report was supported by Fung Ying Seen Koon. We are grateful to the following persons (in alphabetical order) who had provided expertise and help that greatly assisted the research: Members of the Fung Ying Seen Koon Steering Committee for Research Studies: Mr. TAM Kui Lung, Alan (Treasurer) Ms. HUI Siu Fung, Judy (Councillor) Mr. KO Tak Fai (Councillor) Ms. MAK Jenny (Councillor) Mr. TONG See Sin (Councillor) Mr. MA Kam Wah, Timothy (Consultant) Mr. CHAN Kam Ming, Kenneth Ms. CHEUNG Chi Wing, Vera Ms. LEUNG Shuk Yi Members of Policy 21 Limited: Mr. YIP Hak Kwong (Director) Ms. CHONG Hiu Lam, Cherry Ms. LIANG Qimin, Emily

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FUNG YING SEEN KOON CENTRES Fung Ying Seen Koon Tai Po Neighbourhood Elderly Centre Subsidized by the Social Welfare Department, the Centre was established on 1 June 1996, and was upgraded to a Neighbourhood Elderly Centre from 1 October 2014. Objectives To establish a supporting network for the elderly and caregivers, to provide social services to elderly persons to enable them remain in the community, thus leading a healthy, respectful and dignified life, and to assist elderly persons to age in the community. Address: Room 207–213, Beautiful Garden Arcade, 11 Chui Lok Street, Tai Po, New Territories, Hong Kong.

Fung Ying Seen Koon Cheung Wah Neighbourhood Elderly Centre Subsidized by the Social Welfare Department, the Centre was established in 1988, and was upgraded to a Neighbourhood Elderly Centre from 1 October 2014. Objectives To establish a supporting network for the elderly and caregivers, to provide social services to elderly persons to enable them remain in the community, thus leading a healthy, respectful and dignified life, and to assist elderly persons to age in the community. Address: Unit 9–10, Cheung Chi House and Unit 217–222, Cheung Lai House, Cheung Wah Estate, Fanling, New Territories, Hong Kong.

Fung Ying Seen Koon Cheung Lung Wai Integrated Service Centre The Centre is self-funded by the Fung Ying Seen Koon, and was established on 11 November 2016. Objectives To provide community services and establish a community support network for the elderly, to provide referral services so as to enable the elderly persons to remain in the community

and lead a healthy, respectful and dignified life, to assist elderly persons to age in the community, and to help single parents and new immigrant arrivals to integrate into society. Address: 2/F, Cheung Lung Wai Estate Ancillary Facilities Block, Sheung Shui, New Territories, Hong Kong.

EXECUTIVE SUMMARY â&#x20AC;&#x153;Ageing in place as the core, institutional care as back-upâ&#x20AC;? is the main elderly policy in Hong Kong. Services to the elderly and caregivers are provided by service units of community support and residential care in Hong Kong. This study explored the community service needs of elderly singletons, elderly couples and caregivers in Tai Po and the North District, Hong Kong. The study had collected opinions from 423 elderly people and 198 caregiver members of the Fung Ying Seen Koon. Focus groups had also been conducted to collect in-depth and thorough information on the community support needs of elderly people and caregivers. Health condition is the major concern among the elderly in Hong Kong. This study found that the elderly in Tai Po and the North District suffered from two to three chronic diseases, and they considered their health conditions fair or poor. Furthermore, the majority of elderly singletons in this study did not have any person accompanying them to consult doctors. Also, for the elderly with joint disease, eye impairment or hearing difficulties, a large proportion of them did not have anyone to escort them to hospital. It was also found that the children of the elderly were their main caregivers. It is noteworthy that the children of the elderly are also ageing themselves. Thus, it is expected that the elderly population who are being taken care of by their retired/ageing children will keep on increasing. Hence, it is worth exploring the current and future needs of the elderly and caregivers, so as to better improve or maintain the current community support services. It was found that a large proportion of the elderly needed community recreational and social activities. The elderly in excellent or very good health conditions had reported that they have a bigger need for the Elder Academy. The need for physical, psychological, and social health information was also high among the elderly. Some needs of the elderly, such as counselling service, health and home care assessment, remote diagnostic and health consultation were not yet satisfied. The research findings on this will be further elaborated in Chapter 6.

vii

Three service models had been therefore suggested to better assist the elderly to “ageing in place”. The first suggestion was having a comprehensive service vehicle so that community support services and medical services would also be available to the elderly in remote areas. The next suggestion was setting up a gerontechnology centre to test gerontech products and develop a health monitoring system for the elderly. Also, the needs of caregivers should not be neglected and it had been suggested that “caregiver holidays” should be launched for those who have to take care of the elderly for twenty-four hours a day and seven days a week to take a rest, similar to the caregiver holiday scheme in Taiwan.

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CONTENTS Acknowledgements ............................................................................................................. iii Fung Ying Seen Koon Centres ............................................................................................ v Executive Summary ........................................................................................................... vii Chapter 1 BACKGROUND ............................................................................................. 1 1.1 Elderly Policy in Hong Kong 1 1.2 Community Care and Support Services in Hong Kong 1 1.3 Fung Ying Seen Koon (FYSK, 蓬瀛仙館) 2 1.4

Objectives of the Study

Chapter 2 LITERATURE REVIEW .............................................................................. 3 2.1 The Needs of the Elderly 3 2.2 The Needs of the Elderly in Hong Kong 4 2.3 Elderly Services in Hong Kong 5 Chapter 3 STUDY METHODOLOGY ........................................................................... 9 3.1 Study Methodology 9 3.2 Sampling Method 10 Chapter 4 CONCEPTUAL FRAMEWORK ................................................................ 11 4.1 Assessment of Needs 11 Chapter 5 ENUMERATION RESULTS ....................................................................... 13 5.1 Focus Group Discussions 13 5.2 Questionnaire Survey 13 Chapter 6 FINDINGS ..................................................................................................... 15 6.1 The Ageing Population in Tai Po and the North District 15 6.2 Health Condition of the Elderly in Tai Po and the North District 15 6.3 All Alone: Lacks Companion to Visit Doctors 17 6.4 Family Support 17 6.5 Elderly’s Current Needs 19 6.6 Active/Productive Ageing in Society 21

Chapter 7 RECOMMENDATIONS .............................................................................. 29 7.1 Holistic Support — Comprehensive Service Vehicle 29 7.2 Centre with Technology 31 7.3 Caregiver Holiday .................................................................................................. 32 Chapter 8 CONCLUSION ............................................................................................. 35 Appendixes.......................................................................................................................... 37 Table 1. Current needs by district 37 Table 2. Current needs by health status 38 Table 3. Current needs by age group 39 Table 4. Current needs by living status 40 Table 5. Current needs by education attainment 41 Table 6. Future needs by district 43 Table 7. Future needs by health status 44 Table 8. Future needs by age group 45 Table 9. Future needs by living status 46 Table 10. Future needs by education attainment 47 Table 11. Caregivers’ needs 49 Table 12. Elderly’s awareness of community service 50 Elderly’s Questionnaire 51 Caregiver’s Questionnaire 69 References

Tables & Figures Table 1 Table 2 Table 3 Table 4 Table 5

Study methodology Focus group discussions Number of questionnaires collected in the survey Profile of respondents by living district Prioritization matrix of areas of needs — Current needs by the level of satisfaction Figure 1 Three-dimensional framework on the needs of different types of elderly and caregivers Figure 2 Various levels of care support services Figure 3 Perceived health status among the elderly

9 13 14 18 20 11 12 16

Chapter 1 BACKGROUND 1.1

Elderly Policy in Hong Kong

â&#x20AC;&#x153;Ageing in place as the core, institutional care as back-upâ&#x20AC;? is the main elderly policy in Hong Kong. The Chief Executive of Hong Kongâ&#x20AC;&#x2122;s Policy Address 2017 emphasized that, with a general consensus regarding this policy, community care services should be further strengthened.1

1.2

Community Care and Support Services in Hong Kong

There are two mainstreams of services for the elderly in Hong Kong, (1) community care and support services, and (2) residential care services. Both forms of services aim at helping the elderly to live with dignity, maintaining and promoting their well-being including their sense of belonging, security, and worthiness in all aspects of their lives through the provision of a wide spectrum of services. According to the Social Welfare Department in Hong Kong, community care and support services cover three types of services: (1) elderly centre services, (2) community care services, and (3) other support services. Elderly centre services include District Elderly Community Centre (DECC), Support Team for the Elderly (STE), and Neighbourhood Elderly Centre (NEC). The establishment of these service centres is to provide community support at the district and neighbourhood levels, and provide referral services for the elderly and their caregivers. Community care services include Day Care Centre/Unit for the Elderly (DEs/DCUs), Day Respite Service for Elderly Persons, Enhanced Home and Community Care Services (EHCCS), Integrated Home Care Services (IHCS), and Home Help Service (HHS). Apart from the elderly centre services and community care services, there are also other schemes of community support services, including the Senior Citizen Card Scheme, Opportunities for the Elderly Project, Carer Support Service, and Holiday Centre for the Elderly. The Neighbourhood Elderly Centre (NEC) is a type of community support services at the neighbourhood level that provides a range of comprehensive services aiming at enabling 1

Hong Kong Special Administrative Region Government (2017). Policy address 2017. Retrieved from http://www.policyaddress.gov.hk/2017/eng/index.html

the elderly persons to remain active in the community, to lead a healthy, respectful and dignified life and to enhance their positive and contributing roles to society. The Neighbourhood Elderly Centres (NECs) also collaborate with the District Elderly Community Centres (DECCs) to involve the public in building up a caring community.

1.3

Fung Ying Seen Koon (FYSK, 蓬瀛仙館 )

This study was commissioned by the Fung Ying Seen Koon (FYSK), which is a non-profit-making organization providing community support services to the public including the elderly and caregivers at the neighbourhood level. The FYSK has NECs in Tai Po and Fanling, and an Integrated Service Centre (ISC) in Sheung Shui for providing community support services.

1.4

Objectives of the Study

The objective of the study was to explore the needs of the elderly singletons, elderly couples and caregivers in Tai Po and the North District for various community support services, in particular to identify those services that were in need and to be pursued by the above-mentioned centres. The FYSK would then improve the community support services in Tai Po and the North District based on the suggestions in this report.

Chapter 2 LITERATURE REVIEW 2.1

The Needs of the Elderly

Sidney Katz’s Activity of Daily Living (ADL), which could be applied to the elderly, includes wearing clothes, eating, ambulatory, toileting and hygiene,2 whereas the Lawton Instrumental Activities of Daily Living (IADL) includes the ability to use telephone, to undertake shopping, food preparation, housekeeping, laundry, transportation, responsibility for own medication, as well as to handle finances.3 For the ADL, the index is divided into two parts: (1) independence and (2) dependence.4 “Independence” means that the elderly is able to carry out the daily activities without assistance, while “dependence” means that the elderly requires supervision to carry out the daily activities.5 Taking the ADL of hygiene as an example, it means that the elderly can take a bath by themselves without help, or bathe a single part of the body such as the back with some help from others. For the ADL of eating, it means that the elderly is able to take food from the plate without help.6 For the IADL, the ability to undertake responsibility for own medication means that the elderly is able to take medication with the correct dosage at the correct time; the ability to undertake housekeeping means the elderly is able to perform daily housework such as washing dishes and making beds; the ability to undertake laundry means that the elderly is able to do laundry on their own.7 A survey on the support needs of elderly has generalized the need of elderly.8 Elderly with high support needs are the elderly who have: (1) communication issues because of

2 3 4 5 6 7 8

Shelkey, M., & Wallace, M. (1999). Katz index of independence in activities of daily living. Journal of Gerontological Nursing, 25(3), 8–9. Graf, C. (2008). The Lawton instrumental activities of daily living scale. American Journal of Nursing, 108(4), 52–62. Shelkey, M., & Wallace, M. (1999). Katz index of independence in activities of daily living. Journal of Gerontological Nursing, 25(3), 8–9. Ibid. Ibid. Ibid. Katz, J., Holland, C., Peace, S. & Taylor, E. (2011). A better life: What older people with high support needs value. London: Joseph Rowntree Foundation.

cognitive impairment, (2) undue focus on health and care needs and (3) language barriers.9 Their needs can be divided into three categories: (1) social needs, (2) psychological needs and (3) physical needs.10 For social needs, the elderly in the survey liked meeting new friends, valued social interactions, had good relationships with their caretakers, and made contributions to society. For psychological needs, the elderly in the survey reported that they would like to be independent and not to rely too much on their families. For physical needs, the elderly thought that even though they had health problems, they valued a lot on “getting out and about”.11

2.2

The Needs of the Elderly in Hong Kong

It is estimated that by 2030, the elderly aged above 65 will reach 2.1 million in Hong Kong, which is twice as that in 2014. With the increasing elderly population, needs for caring and supporting services for the elderly as well as their caregivers will be inevitably increasing, especially considering the increasing elderly dependency ratio. The survey on service needs of aged grassroots caregivers conducted by the Society for Community Organization, identified that the elderly and aged caregivers were in need of healthcare services. 12 According to the survey, the elderly had health issues such as high blood pressure, arthritis, and dementia.13 The elderly in Hong Kong also requires caregivers to assist them in activities such as consulting the doctor, taking medication, carrying out housework and food preparation, as mentioned in ADL and IADL above. The elderly with high support needs rely on caregivers to perform such tasks.14 According to the survey conducted by the Hong Kong Policy Research Institute, over 140,000 elderly people who were ageing in place could not have proper care.15

9 10 11 12

13 14 15

Ibid. Ibid. Ibid. 香港社區組織協會 (2017)。《以老護老：基層年長護老者服務需要問卷調查報告》( 立法會 CB(2)1080/16-17(01) 號文件 ) 。取自 https://www.legco.gov.hk/yr16-17/chinese/panels/ltcp/papers/ ltcp20170328cb2-1080-1-c.pdf Ibid. Ibid. 香港政策研究所（ 2017 ）。《居家安老：家庭與社區的照顧及支援》。取自 http://www.hkpri.org.hk/storage/app/media/Research_Report/20170611_aging_in_place_report_web.pdf

According to the survey conducted by the Elderly Rights League, the elderly in Hong Kong also had medical needs. The survey showed that the elderly was using medical services 17.4 times every year on average. This depicted a great demand of medical services for the elderly in Hong Kong.16

2.3

Elderly Services in Hong Kong

2.3.1 Community level To cater for the above needs of the elderly in Hong Kong, the Government and social welfare organizations provide services at different levels: (1) community level and (2) residential level. At the community level, the Social Welfare Department provides services through units such as DECCs, NECs, DEs/DCUs, EHCCS, IHCS and HHS. These units provide services such as health education, meal and laundry services, and escort services to the elderly.17 2.3.2 Residential level At the residential level, the Social Welfare Department subsidizes the Residential Care Services for the elderly of age 65 or above and who cannot be taken care of at home because of personal, social, health and/or other issues. For example, the Care and Attention Home for the Elderly provides residence, catering, and personal and nursery care for the elderly who are unable to take care of themselves.18 2.3.3 Existing elderly services For medical services, the elderly patients stated that the waiting time at the public specialist out-patient clinics was quite long. The average waiting time was as long as 14.9 months, and 70.6% of the elderly believed that the long waiting time for medical services would aggravate their health condition, make their living inconvenient and add pressure to their lives.19 Moreover, 64% of the elderly stated that the consultation time of doctors was inadequate. They mentioned that the doctors would neither explain their health condition nor answer questions raised by the elderly patients. This revealed that there was a shortage

香港老人權益聯盟（2016）。《「基層長者健康需要」問卷調查報告》。取自 https://soco.org.hk/ soco_past/publication/elderly/survey_2018_9_23.docx 香港政策研究所（ 2017 ）。《居家安老：家庭與社區的照顧及支援》。取自 http://www.hkpri.org.hk/storage/app/media/Research_Report/20170611_aging_in_place_report_web.pdf Hong Kong Social Welfare Department (2019). Care and attention homes for the elderly. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_residentia/ id_careandatt/ 香港老人權益聯盟（2016）。《「基層長者健康需要」問卷調查報告》。取自 https://soco.org.hk/ soco_past/publication/elderly/survey_2018_9_23.docx

of doctors in the public healthcare sector. Also with the lack of resources, the medical needs of the elderly could not be satisfied.20 Another problem of elderly services is the lack of service information. Although there are many services catered for the elderly as mentioned above, not many of the elderly and caregivers know the elderly services provided by the government. According to a survey conducted by the Sau Po Centre on Ageing in 2011, 93.3% of the elderly informants did not use any of the elderly services provided by the government, 17.4% of the elderly had never heard of the services, 13.1% of the elderly did not know how to apply for the services, and 9.5% of the elderly could not afford the service fee.21 This shows that because of the lack of information on the elderly services, some of the elderly who were in need could not get any assistance from the government. The same survey showed that not only did the elderly not know the services provided by the government, the caregivers also did not know about the information, and 11.6% of the caregivers in the survey had never heard of the services.22 As the elderly with high support needs relied on their caregivers for obtaining information and services, the lack of accessibility to the services had added burden and pressure to both the elderly and caregivers. Apart from the problem of lacking service information, the services provided for the elderly were also said to be lacking flexibility. Since the service hours were from 8 am to 6 pm, the needs of the elderly at night and after midnight could not be catered for.23 The demand for the Home Care Services which are provided by NGOs and funded by the Social Welfare Department has exceeded the supply. In 2011, there was a supply of 6,199 quotas for Home Care Services, whilst the demand for the services was 60,754 cases.24 Thus, the waiting time for the Home Care Services was lengthened, and the average

22 23

香港社區組織協會（2017）。《以老護老：基層年長護老者服務需要問卷調查報告》（立法會 CB(2)1080/16-17(01) 號文件）。取自 https://www.legco.gov.hk/yr16-17/chinese/panels/ltcp/papers/ ltcp20170328cb2-1080-1-c.pdf 香港大學秀圃老年研究中心、社會工作及社會行政學系（2011）。《長者社區照顧服務顧問研究研究報告》。取自 https://www.elderlycommission.gov.hk/cn/download/library/Community%20Care%20 Services%20Report%202011%20chi.pdf Ibid. 陳章明（2016 年 4 月）。〈未來五年長者居家安老及社區照顧發展前瞻及挑戰〉。《麥絡》，55 (2016 年 4 月)，1–2。取自 http://www.skhlmc.org/ni/20160225-165144_55-final-20160225.pdf 陸偉棋、余婉華（ 2012 ）。《老有所依？完善社區及院舍安老服務的策略》。取自 http://www.ideascentre.hk/wordpress/wp-content/uploads/2009/02/e5ae8ce59684e7a4bee58d80e58 f8ae999a2e8888de5ae89e88081e69c8de79a84e7ad96e795a5-tc.pdf

waiting time was 20 months for the Integrated Home Care Services (Frail cases)/Enhanced Home and Community Care Services whereas 12 months for the Day Care Services.25 The Consultancy Study on Community Care Services (CCS) for the Elderly had proposed that the service hours, scope of services and operation space should be improved. Accordingly, the improvements would increase the support services for family caregivers and provide more transitional care and respite services. The existing funding mode and service performance monitoring system should be fine-tuned as well.26

Social Welfare Department (2019). Waiting list for subsidised community care services for the elderly. Retrieved from https://www.swd.gov.hk/storage/asset/section/2789/en/LTC_Statistics_CCS(Eng)(Jul_ 2019).pdf Sau Po Centre on Ageing, & The University of Hong Kong, Department of Social Work & Social Administration (2011). Consultancy study on Community Care Services for the Elderly. Retrieved from https://www.elderlycommission.gov.hk/en/download/library/Community%20Care%20Services%Report% 202011_eng.pdf

Chapter 3 STUDY METHODOLOGY 3.1

Study Methodology

In this Survey, both quantitative and qualitative data were obtained from the elderly and caregivers. Questionnaire survey and focus group discussions were conducted with the elderly of age 60 or above and caregivers (Table 1). The purpose of collecting the qualitative information was to facilitate the drawing of hypothetical examples used in the questionnaire and to enrich the findings obtained from the questionnaire. Table 1. Study methodology Phase I Pre-survey

Phase II Main-survey

â&#x20AC;&#x201D;

Questionnaire survey & 4 focus group discussions

1 focus group discussion

Questionnaire survey & 2 focus group discussions

The elderly (elderly singletons, elderly couples) Caregivers (informal caregivers and formal caregivers)

3.1.1

Focus group discussion

To obtain more in-depth information about the topic, six focus group discussions were conducted with the elderly and caregivers. Four focus group discussions were conducted with the elderly with different profiles: (1) young-olds, with low support needs, (2) old-olds, with high support needs, (3) elderly singletons and (4) elderly doubletons. Besides, two focus group discussions were conducted with the informal and formal caregivers: (1) informal caregivers such as elderly volunteers and family members who took care of the elderly and (2) formal caregivers such as occupational therapists. 3.1.2

Questionnaire survey

The questionnaire survey was conducted with the elderly and caregivers at the service centres of the FYSK, including the FYSK Tai Po NEC, FYSK Cheung Wah NEC and FYSK Cheung Lung Wai ISC from 14 December 2017 to 2 June 2018.

3.2

Sampling Method

3.2.1

Target respondents

The target respondents were the elderly of age 60 or above and their caregivers shortlisted from the membership of the abovementioned service centres of the FYSK. Occupational therapists from the North District Hospital were also invited to the focus group discussions. 3.2.2

Sample design and sample size

3.2.2.1 Focus group discussions A representative sample is not required in selecting participants for a focus group discussion. However, it is necessary to ensure that the views of different target groups are sought in the discussions. Four discussion groups with the elderly who lived alone, elderly couples, as well as young-olds and old-olds, and two discussion groups with caregivers (including formal and informal caregivers) were convened. Elderly with different demographic backgrounds, for example, age (i.e., young-old and old-old), education level and living arrangement, were recruited. 3.2.2.2 Interviews with the elderly and caregivers 600 elderly and caregivers were randomly selected to participate in the survey. With an effective sample size of 600, the precision of the estimates was expected to be within the range of plus/minus 3.4 percentage points at 95% confidence level, assuming simple random sampling. The precision of the estimates at the sub-group level was expected to be lower.

Chapter 4 CONCEPTUAL FRAMEWORK 4.1

Assessment of Needs

To assess the needs of the elderly and their caregivers, it is essential to cover the needs of the elderly at different stages, including young-old and old-old, and the transitional phase from middle-aged to young-old, and from young-old to old-old. Fig. 1 is a three-dimensional framework on the needs of different types of elderly and caregivers. Figure 1. Three-dimensional framework on the needs of different types of elderly and caregivers (copyright by the FYSK) Living Status Singleton Couple only With children/other family members Abled Frail Long-term care

Middle Young- Oldaged old old

Life span during adulthood

Physical functioning

While it is important to cover the needs from various aspects, it is also crucial to distinguish the needs of different types of elderly people. Fig. 2 describes the various levels of care support services given to the elderly. While the needs of the elderly with different levels of impairment, at different age stages, and in different living arrangements would be considered, the transitional needs between

the stages should be taken into account in the assessment as well, because the occurrence of important life events (e.g., sickness of oneself and the caregiver, etc.) would significantly affect the needs of each elderly people. Figure 2

Various levels of care support services (copyright by the FYSK)

Societal care Community care

Family care

Self-care

Therefore, emergency needs, transitional needs, and regular needs of the elderly and their caregivers were also evaluated in this study, with immediate or future needs being distinguished.

Chapter 5 ENUMERATION RESULTS 5.1

Focus Group Discussions

Six focus group discussions were conducted, of which four were targeted to the elderly and two to the caregivers. The types of participants involved were: (1) young-olds with low support needs, (2) old-olds with high support needs, (3) elderly singletons, (4) elderly doubletons, (5) informal caregivers, and (6) formal caregivers. (Table 2) Table 2. Focus group discussions Group

Date

Young-olds, with low support needs

29/12/2017

Cheung Lung Wai ISC

Old-olds, with high support needs

30/12/2017

Tai Po NEC

Elderly singletons

5/1/2018

Cheung Wah NEC

Elderly doubletons

23/1/2018

Cheung Wah NEC

Informal caregivers

3/1/2018

Cheung Lung Wai ISC

Formal caregivers

10/1/2018

North District Hospital

5.2

Location

No. of participants

No.

Questionnaire Survey

A questionnaire survey was conducted with the elderly members and caregivers in the service centres of the FYSK, including the Tai Po NEC, Cheung Wah NEC, and Cheung Lung Wai ISC. A total of 621 questionnaires were collected, with 423 from the elderly and 198 from their caregivers. Table 3 shows the number of questionnaires collected in the survey.

Table 3. Number of questionnaires collected in the survey Venue

Elderly

Caregivers

Tai Po NEC

139

Cheung Wah NEC

127

Cheung Lung Wai ISC

157

423

198

Total

Chapter 6 FINDINGS 6.1

The Ageing Population in Tai Po and the North District

According to the 2016 Population By-census, the ageing population has increased tremendously in the past ten years. The proportion of elderly in the whole population has increased from 12.4% in 2006 to 15.9% in 2016, while the total elderly population has increased by 36.4% in 2016.27 For the age distribution, 53% of the elderly were of age between 65 and 74, 17.7% between 75 and 79, and 29% above 80.28 In this study, of the 423 elderly members interviewed, 139 were from Tai Po and 284 from the North District. The profile of the respondents skewed towards the female, with a female to male ratio of around 5.7:1. The age of the elderly respondents ranged from 60 to 94, with 27.9% under 70, 41.0% between 70 and 79, and 31.2% 80 or above. Concerning the martial status, 61.4% were widowed, 25.8% were married, and 11.4% were divorced or separated. Over half of the respondents were elderly singletons, which is comparatively higher than the ratio of elderly singletons in Hong Kong. The proportion of the education level among the respondents in Tai Po and the North District was slightly lower than that in the entire Hong Kong ageing population.

6.2

Health Condition of the Elderly in Tai Po and the North District

Health wellness is a major issue among the elderly in Hong Kong. Over 60% of the elderly in Hong Kong considered their health status fair or poor, which was nearly double of that of the population of age 15 or above in Hong Kong.29 In our study, one-tenth of the elderly perceived themselves as having poor health status. (Fig. 3) One of the key concerns about the elderly’s health condition is their chronic illness and physical impairment. On average, the elderly had two to three chronic diseases, and only less than 10% of them did not have any. Those who reported in fair or poor health had significantly more chronic diseases.

28 29

香港特別行政區政府統計處（2018）。《香港 2016 年中期人口統計 https://www.statistics.gov.hk/pub/B11201052016XXXXB0100.pdf Ibid. Ibid.

— 主題性報告：長者》。取自

High blood pressure, hypercholesterolemia, and joint disease were the top three popular diseases among the elderly respondents.. Aside from these, eye disease, diabetes, di and hearing impairment were also troubling at least 15% of the elderly in Tai Po and the North District. Figure 3.

Perceived health status among the elderly (%)* (%)

* The total percentage was 100.1%

As a normal ageing process, changes related to vision, hearing, muscles and joints, and memory are common and require great attention. These changes might not only affect the physical condition of the elderly and their daily li lives,, but also influence their mental health. Some of the changes induced by illness might lead to further medical consultation required. According to the thematic hematic report on older persons in 2017, 35.8% of persons aged 65 or above had consulted doctor in the past month of the survey, and 18% of persons aged 65 or above had been admitted to hospitals in the past month of the survey. survey 30 However, our study showed that nearly half of the elderly ha had consulted a doctor in the past month. On average, the frequency of doctor consultations was twice per month. In addition, around one in every four of the elderly in our study had been admitted to the hospital in the previous year. While the majority of them had been admitted to the hospital 30

Ibid.

for only once, the readmission rate to the hospital was as high as 25%.

6.3

All Alone: Lacks Companion to Visit Doctors

Family members were assumed to take the largest responsibility for taking care of their aged family members. For those elder respondents who were accompanied to hospitals, 48.3% were accompanied by their children, and 35.0% by their spouses or partners. Foreign domestic helpers and friends of the elderly were also helping. Unfortunately sad for the elderly singletons, 86.7% of them had no company when visiting hospitals. Even for those with joint disease, eye impairment and hearing difficulties, still a large proportion of them did not have anyone to escort them to the hospital.

6.4

Family Support

Overall, 40.9% of the elderly reported that they had no family members to take care of them. For elderly singletons, the percentage was up to 60%. The capability of being independent might be the key reason why the elderly did not need a caregiver, especially those in good health condition. There was a difference between the residents in Tai Po and the North District. While 29.2% of the elderly in Tai Po indicated that they did not have a family member taking care of them, the percentage for the elderly in the North District was 46.3%. For those with caregivers, their children were their main supporters (65.7%). Their spouses were the second (21.1%). According to the respondents from the focus groups, they tended to rely more on their sons and daughters when they had to consult doctors or had medical appointments. This is especially true for the elderly with high support needs, for example, the elderly who were immobile or had difficulties in walking. The sons and daughters could provide better support, such as helping to push wheelchairs. Besides, some elderly considered that taking care of older parents were the childrenâ&#x20AC;&#x2122;s obligations, following the traditional Chinese filial piety custom. Some of the elderly had pointed out that their caregivers needed to take care of them five days a week on average. Overall, over half of the caregivers needed to take care of the elderly everyday (54.9%). The average number of hours spent on taking care of the elderly

was 6.8 hours per day, with 44.6% spending less than four hours, 29.4% ranged from four to eight hours, and 26.0% spending eight hours and more. Table 4 describes the profile of the respondents in Tai Po and the North District. Table 4. Profile of respondents by living district*

Gender Age

Marital status

Living status

Overall

Tai Po

North District

Male

14.9%

16.8%

13.4%

Ageing population in Hong Kong* 46.0%

Female

85.1%

83.2%

86.6%

54.0%

60–69

27.9%

25.7%

29.2%

34.0%

70–79

41.0%

34.6%

43.8%

36.7%

80 and above

31.2%

39.7%

27.0%

29.3%

Married or cohabited

25.8%

19.7%

28.4%

63.4%

Divorced or separated

11.4%

8.8%

12.8%

4.7%

Widow

61.4%

70.8%

57.1%

27.8%

Never married

1.4%

0.7%

1.8%

4.2%

Singleton

50.8%

50.4%

50.9%

13.1%

Couple only

11.3%

8.8%

12.4%

25.2%

Others

37.8%

40.9%

36.7%

48.5%

No schooling or pre-schooling education

40.0%

32.8%

43.5%

Primary school Secondary school or above

39.2%

45.3%

36.4%

20.8%

21.9%

20.1%

Educati on level

60.4% 39.6%

Note:

# Living with partner and children, living with children/grandchildren only, or living with domestic helper. Source: https://www.bycensus2016.gov.hk/data/16BC_Older_persons_report.pdf, pp. 5–9. * All figures, including percentages, are estimates. Percentages may not add up to or exceed 100% due to rounding or because multiple responses are allowed. For the “Age – Overall” column, the total percentage was 100.1%. For the “Marital Status – North District” & “Ageing Population in HK” columns, the total percentage of both of them were 100.1%. For the “Living Status – Overall”, “Living Status – Tai Po” & “Living Status – Aging Population in HK” columns, the percentage of them were 99.9%, 100.1% and 86.8% respectively.

6.4.1

Stress on working caregivers

Apart from work, the “children caregivers” needed to take care of their aged parents after work for the rest of the day. The majority of the “children caregivers” was working as full-time employees (69.3%). In addition to their full-time job, they had to take care of their aged parents for five hours on average daily, while 55.6% of them took care of their parents for less than four hours, 29.9% ranged from four to eight hours, and 14.5% for more than eight hours. 6.4.2

Ageing caregivers on the rise

Elderly taking care of the elderly is getting more common, and 12.1% of the “children caregivers” had already retired from their job. With the growing ageing population, it is expected that the number of elderly taking care by their retired children will keep on increasing.

6.5

Elderly’s Current Needs

From the elderly’s point of view, what they currently needed most were community recreational activities (72.1%), social activities (65.2%), the Elder Academy (44.1%), outreach home visit service (38.6%), participation in elderly volunteer work (37.7%), gerontechnology and tools (31.7%), physical, psychological, and social health information (31.0%), home help service (17.7%), cognitive training service (14.3%), and neighbourhood support or respite service (13.2%). In order to support the elderly and their caregivers, community services were getting increasingly diverse to satisfy their needs. While there was a high need for community recreational activities, social activities, the Elder Academy, outreach home visit service, volunteer work, gerontechnology and tools, and health information, many of the elderly thought their needs were satisfied. This result was also in consistence with the current practice. The DECCs and NECs are making efforts in providing diverse activities to satisfy the needs of the vast majority of the elderly. To keep them active within the community, the elderly are engaged in more volunteer work. DECCs and NECs would also arrange volunteers, social workers, and other professionals for outreach home visits, and in the meanwhile encourage more usage of technology to improve the elderly’s lives. However, some areas were yet to be improved. A high level of unmet rates was observed

among the aspects related to home services and community health care, especially the preventive care services, even though only a small proportion of the elderly might have the urge to seek help in these areas. Table 5 below further elaborates the areas of needs of the elderly and whether the current services could satisfy their needs. Table 5. Prioritization matrix of areas of needs â&#x20AC;&#x201D; Current needs by the level of satisfaction Area of needs First priority: High level of current needs, high level of unmet Areas to maintain: High level of current needs, low level of unmet

Second priority: Low level of current needs, high level of unmet

Low priority: Low level of

Elderly community care service

Percentage of need in the future

None Gerontechnology and tools

36.7%

Physiological, psychological, and social health information

28.1%

Outreach home visit service

20.3%

Participation in elderly volunteer work

16.5%

Elder Academy

16.0%

Community social activities

10.7%

Community recreational activities

7.1%

Home care service

50.1%

Home help service

43.9%

Service matching/service referral

43.2%

Remote diagnostic and health consultation

41.5%

Community rehabilitation service

36.8%

Health and home care assessment

36.6%

Community meal/laundry service

36.3%

Counselling service

31.6%

Cognitive training service

31.4%

Financial management information

25.7%

Neighbourhood support/respite service

29.4%

current needs, low level of unmet Note: Only include items with no less than 30 valid answers for Q19b: â&#x20AC;&#x153;To what extent do you think you need the following elderly community care service now? If you are in need, can the current service satisfy your needs?â&#x20AC;? The cut-off is the average level of these items (i.e., 24.6% for current need, 26.6% for the unmet level).

6.6

Active/Productive Ageing in Society

6.6.1

Community activities and the Elder Academy

Generally speaking, staying active in the community and socially engaged are important to the elderly. A large proportion of the elderly reported that they needed community recreational (72.1%) and social activities (65.2%). Nearly half of them were expecting to learn more, build and maintain their interests and remain knowledgeable about what was happening in the society by attending the Elder Academy (44.1%). The needs for community activities and the Elder Academy were higher for residents in Tai Po than those in the North District, being 82.4% and 51.5% respectively (see Appendix: Table 1). The reason for the difference could be related to geographic factors. The engagement in community activities among the elderly couples showed a good signal. Specifically, the need for community recreational activities, social activities and the Elder Academy for elderly couples were also higher (83.3%, 74.5%, and 55.3% respectively) (see Appendix: Table 4). However, it is of concern that with the increasing age, the elderlyâ&#x20AC;&#x2122;s interests and needs in recreational and social activities and the Elder Academy would significantly drop. One of the possible causes could be the influence of their health condition. The elderly in excellent or very good health condition had reported a higher level of need for the Elder Academy (55.9%) (see Appendix: Table 2). On the other hand, only 40.5% of the elderly in fair or poor health condition had reported the need for the Elder Academy. The majority of the elderly in Hong Kong is still having good health, with good functional capabilities in their daily lives and low in their dependence level. When the activities match their expectations and the time is appropriate, they would be more likely to attend the activities and explore their interests. In the focus group with the young-olds, they mentioned that they would like to join the activities in the FYSK because they would like to have a meaningful life after retirement and believed the activities could really help.

For the elderly in poorer health, they might have greater restrictions in joining the community activities. Among the elderly in poorer health, 15.4% of them thought that their needs for community social activities had not been met (overall is 6.9%). While designing activities to match the expectation for the majority of the elderly, how to make adjustments for the elderly in poorer physical health condition is also worth exploring. 6.6.2

Elderly volunteer work

Apart from entertainment, the elderly were also looking for self-fulfilment by joining volunteer work. Over one third of them indicated their need for participating in volunteer work to keep on contributing to society (38.6%). Nonetheless, the actual rate of elderly volunteering was not as high as the need for it. Only around one in four of the elderly reported participation in volunteer work in the past year according to a research conducted in 2016.31 Our results also showed that around 10% of the elderly with the need for participating in volunteer work reported their need was unmet. Young-olds were more in need of participation in volunteer work (56.0%), comparing to their older cohorts. With the increase in age, their need for volunteer work was decreasing. With reference to the focus groups, the young-olds were more open to participate in elderly volunteering to help other elderly. Comparatively, the elderly in good health condition had a higher need for volunteer work. As an extension to their work lives, volunteer work could help maintaining their self-esteem by assisting other people in need and engaging in meaningful events. Whereas, taking part in volunteer work might also help them maintain good health, both physically and mentally. According to a survey on volunteering of older people in Hong Kong,32 the motivations for the elderly to volunteer were that they were able to contribute to society, and gain happiness and respect when they help people in need. They also believed that elderly volunteering would provide them with lifelong learning opportunities.33 6.6.3

Healthy ageing in society

While being active and productive is important, staying healthy is fundamental. The 31 32 33

Hong Kong Institute of Volunteers (2016). Topical study on volunteering of older people in Hong Kong. Retrieved from http://www.avs.org.hk/files/hkiov/20160322forum/HKIoV_Study_Report_ Eng_v2.pdf Ibid. Ibid.

elderly need health information, more knowledge on their health condition, professional consultation, and health care to stay active and productive. For the elderly who are frequent visitors of doctors and/or hospitals, the continuation of health care in the community, like community rehabilitation, is also crucial in keeping them healthy in place. The study reflected the demands for physical, psychological and social health information were high among the elderly (31.0%). Residents in Tai Po were especially looking forward to accessing such health information from the community services (38.5%) (see Appendix, Table 1). The elderly with higher level of education attainment concerned themselves more about the provision of health information, and 37.5% of the elderly with the education level of secondary school or above reported needs for physiological, psychological and social health information. More channels to health information should be made available to the elderly. As people age, their cognitive ability will deteriorate accordingly. Memory impairment and dementia are the major issues among the elderly. Unfortunately, cognitive training service is not as common as the provision of health information within the community. The elderly with higher education level cared particularly about the need for cognitive training service(s) (12.3% for no schooling or pre-schooling, 14.5% for primary school, and 17.6% for secondary school or above). The elderly of younger age tended to care about cognitive training more (17.5%, 16.8%, and 7.3% respectively for the elderly of age 60s, 70s, and 80s or above). Although the reported need for cognitive training was slightly less than 15%, one-third of the elderly in need of this service felt that their needs were unmet. The unmet level was significantly higher among the elderly aged 70 or above (40.7%), and the issue was more prominent among the male elderly (62.5%) and the residents in Tai Po (44.4%). Further studies might be needed to explore more about the efficacy of cognitive training services, such as the participation rate among different groups of people from different regions, their satisfaction rate on such programmes, etc. Apart from cognitive training services, the support for preventive health care services in the community was also not sufficient. For example, counselling service, health and home care assessment, remote diagnostics and health consultation were high in the unmet rate. More than one in ten of the elderly were in need of counselling service, but 32.6% of those in need thought their needs were not satisfied. Even worse, nearly half of the elderly in need of health and home care assessment or remote diagnostics and health consultation did

not consider that their needs had been met. For health and home care assessment, the unmet level was 44.4%, and the unmet level of the need for remote diagnostics and health consultation was 46.7%. Community rehabilitation service was another concern, with 38.9% of the elderly in need unsatisfied. Particularly for those who had been admitted into hospital in the past year, 14.9% of them thought their needs for community rehabilitation had not been properly met. Developing a systematic and comprehensive community care aiming at health maintenance was the key to extend the years for the elderly ageing in place. Therefore, even though there was only a small proportion of the elderly demanding health care support in the preventive level or at the rehabilitation stage, the high level of unmet rate still called for further efforts. 6.6.4

Gerontech assistance in the elderlyâ&#x20AC;&#x2122;s life

Technology could be one of the great solutions in providing support for the elderly, not only at the individual and/or family level, but also at the community level. In the present fast-changing world, technology has penetrated into every field of our daily life, and the impact has also affected the elderlyâ&#x20AC;&#x2122;s life. Nearly one-third of the elderly responded that they currently had needs for gerontech and tools (31.7%). The need for gerontech and tools was exceptionally high among the elderly singletons (41.1%), comparing to the elderly couples (27.1%), and the elderly with other marital status (20.0%). Without a companion and living alone, elderly singletons were looking for more assistive technology and other gerontechnological tools to ease their lives and help them with ageing in place. According to the experience of aged people using gerontechnology, they thought using gerontechnology was convenient, and would increase their sense of security.34 Gerontechnology users also reported that the technology had enabled them to receive health care services more easily and thus promoted their social health and well-being. With the help of gerontechnology, the elderly could actively manage their own health condition and hence promote their self-care.35

Kupiainen, T., & Jansson, T. (2017). Aged peopleâ&#x20AC;&#x2122;s experiences of gerontechnology used at home: A narrative literature review (Bachelor thesis). Retrieved from https://www.theseus.fi/bitstream/ handle/10024/129279/Jansson_Kupiainen_ONT_21.4.17.pdf Ibid.

The old-olds in Tai Po and the North Districts were also aware of their needs for using gerontechnology and tools, and 41.1% of the elderly aged 80 or above indicated that they currently needed gerontechnology, which was significantly higher than their younger cohorts (19.5% for the elderly in their 60s, and 32.6% for those in their 70s). 6.6.5

â&#x20AC;&#x153;Come-inâ&#x20AC;? care and home service

Nearly four in ten of the elderly preferred having outreach visiting services. The need among the respondents in the North District was even higher, at 43.6%. Home help service was one of the top ten most needed services by the elderly, specifically those in poor health condition. Overall, 17.7% of the elderly considered they had current needs for home help service, while the percentage for those with fair or poor health was 20.7%. In addition, home care service was also significantly important for those in fair or poor health condition, and 16.0% of the respondents reported having the need for home care service. 6.6.6

Community capital

Family care was the major support for the elderly, but home help service and neighbour support as well as respite service were also important for both the elderly and their caregivers, with 13.2% of the elderly looking forward to neighbourhood support and respite service. Fortunately, most of those in need of such supports thought there were sufficient services (the unmet rate was 18.0%). Charity groups and NGOs provided meal services to eligible elderly in different types of elderly centres and other settings. According to our study, although only 7.7% reported needs for community meal and laundry service, 46.7% of them thought their needs were not satisfied. Moreover, 36.3% of the elderly thought that they would need this service in the future. The young-olds were even more likely to report this need in the future (44.3%). Slightly more than 10.0% of the elderly indicated their needs for service matching and referral. After all, 32.6% of them were not contented with the current services.

6.6.7

Elderly needs ahead

Even though the majority of the elderly might not have specific needs currently, service providers still needed to be well prepared for not just current needs, but also the possible demands in the future. It was observed that some neglected areas with high unmet level were also the services which the elderly might need in the future (see Appendix: Tables 4 and 6). Among all the services, home service was an area where a large number of elderly thought they would need. More than half of the elderly indicated that they would need home care services in the future (50.1%). Around four in ten of the elderly thought they would need home help service (43.9%), and home rehabilitation services (39.1%). While the elderly in good health condition indicated a high likelihood of needs for home help in the future (54.2%), those in poorer health reported greater needs for home rehabilitation (44.3%). Continuity of health rehabilitation was important. Other than home rehabilitation services, community rehabilitation service might be required as well in the future for the elderly (36.8%). On the other hand, 41.0% of the elderly thought they might need discharge support service in the future, especially the elderly in poorer health (46.9%). Apart from being the perception of the elderly, the fact that this population visits doctors frequently, and are often re-admitted into hospitals confirms that the service on health rehabilitation is needed with an increasing tendency in the future. Sufficient support from community health care will relieve the pressure of health care in hospitals. High demands for gerontech and tools were not just a current phenomenon, but were also expected to be on a rise in the future. 36.7% of the elderly thought they would need gerontech and tools for help in the future. As for the elderly in poorer health, greater needs on remote diagnostics and health consultation were perceived in the future (46.9%). Given the service varieties and differences in accord with the elderlyâ&#x20AC;&#x2122;s health condition, service matching or referral were expected to be needed in the future (43.2%). More than half of the elderly in excellent or very good health saw themselves in need of service matching in the future. For escort service, 40.2% of the elderly in this study considered they might need transportation escort in the future, and 36.3% might need escort in community activities like shopping and also other daily assistance.

6.6.8

Mobile clinic service

The majority of the elderly required to have regular medical consultation (either Chinese or Western), acupuncture, massage, medical treatment, health assessment (including consultation and assessment), and medicine enquiries and management. This would constitute a considerable work load for their caregivers. Thus, 42.4% of caregivers indicated that they would apply for the mobile clinic service whenever possible. Among them, 36.9% thought the service should be free of charge, and 54.8% accepted a service charge of HK$60 per hour or below. 6.6.9

Caregiverâ&#x20AC;&#x2122;s needs

In order to support the elderly, less than 10% of the caregivers had employed local domestic helpers, 11.7% had hired foreign domestic helpers, and 11.6% had hired home helpers. In addition, a small proportion of caregivers had arranged community care for the elderly. More than half of the caregivers did not use the community service because the elderly could take care of themselves or were being taken care of by their family members. In conclusion, the reasons for not applying for or using the community care were the caregivers had low awareness of the service itself, had no idea of how to apply, and had financial concerns. 6.6.10

Perception on elderly care

On the whole, 88.4% of caregivers were looking forward to a flexible mode of service to cater for the elderlyâ&#x20AC;&#x2122;s needs, and 73.2% of them thought that the matching of community support should be determined by professional assessment. A vast majority of caregivers accepted that community support could be provided by trained elderly volunteers (90.4%). Nearly all the caregivers agreed on the benefits of having neighbourhood support (97.5%). Nearly nine out of ten of the caregivers agreed that the use of information and communication technology could help the elderly access better community care. However, only 54.3% were willing to purchase gerontech products. Even fewer of them (35.7%) would be willing to pay more for quality community care, while 85.3% of them wished to have more contingency arrangement for community support. 6.6.11

Health care support for the elderly

In order to take care of the elderly, their caregivers would seek for more health knowledge (61.1%) and health information (57.1%), such as how to use health care vouchers and the information on community care services. They would like to attend caregiving courses as well (37.9%). 6.6.12

Support for caregivers

Furthermore, support for caregivers themselves is also important. Caregivers were willing to participate in caregiver sharing and other supportive activities, and acquire information on maintaining their own social, physical and psychological health.

Chapter 7 RECOMMENDATIONS Based on the above findings, the following recommendations are suggested:

7.1

Holistic Support — Comprehensive Service Vehicle

7.1.1

Step further to cover all

Looking into the future, more flexible, diversified and quality elderly services would be needed for supporting an elderly to live a long and healthy life. Considering the development of services for the elderly, “to further streamline and promote integrated service delivery” is one of the key strategic directions proposed in the Government Elderly Commission’s Elderly Services Programme Plan.36 Supported by the Community Chest, the Sai Kung District Community Centre has established the outreach primary health care service, with a team of professionals including social workers, registered nurses, physical therapists, health workers, programme workers, therapy assistants, and care attendants, to introduce health information, provide intervention, foster community care, and give a holistic support to help the elderly “ageing in village”.37 Through the flexible mode of the holistic support system, this programme replaces the “centre-based” approach with the “outreach” care model and provides services within the village by setting up an “in-village” service point. Support for the elderly in remote areas has to be considered in Tai Po and the North District as well. There are 117 villages in the North District and 122 villages in Tai Po, which are twice the number of villages in Sai Kung District (91). However, community facilities are limited in the remote villages, where it might not be cost effective to build a community centre to provide services as the residents are scattered.38 The service hours and cost also hinder the elderly, especially the frail elderly or elderly with impairment from

Working Group on Elderly Services Programme Plan (2017). Elderly Services Programme Plan. HKSAR: Elderly Commission. Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ ESPP_ Final_Report_Eng.pdf 簡敏棋（2017 年 9 月）。〈針對鄉郊長者的基層醫療：西貢區社區中心「鄉村公益樂延年」個案分析〉。《社聯政策報》，23（2017 年 9 月），39–44。取自 http://hkcss.org.hk/uploadfileMgnt/0_ 2017101012240.pdf 香港社會服務聯會（ 2013 ）。《香港社會發展系列 — 社區檔案：北區》。取自 https://www.socialindicators.org.hk/sites/default/files/shares/files/publication/Community_Profile.pdf

visiting NECs and medical clinics/hospitals. A comprehensive service vehicle would be a more proactive approach to reach and provide support for those elderly. According to an evaluation study on mobile clinic for the elderly in Sham Shui Po, the mobile clinic visits not only raise health awareness and foster a healthy living style among the elderly, but also help to identify the potential health problems of those who have not used any health care services before.39 The FYSK has established its Chinese Medical Vehicle Service since 2002 to support the health needs of the elderly in remote villages in Tai Po and the North District. The services provided include general medicine and general surgery, medical consultation, medicine delivery, and other health-related educational activities. It is suggested that services provided by the Chinese Medical Vehicles could be further expanded and enriched. In regard to the reported need of community rehabilitation, health information, cognitive training, and health and home care service, it would be preferable to have a mix of Chinese and Western medical services provided on the vehicle. The Comprehensive Service Vehicle could provide medical consultation (either Chinese or Western), massage, medical treatment, acupuncture, health assessment (including mental health assessment), medicine enquiries and management. Moreover, the vehicle could also serve as a mobile NEC and provide information of upcoming activities in the FYSK NECs and other health information for the elderly living in remote areas. In addition to the team of professionals, the success of the Comprehensive Service Vehicle also relies on the support of residents. The engagement of volunteers and the women or â&#x20AC;&#x153;soon-to-be oldâ&#x20AC;? labour force would bring forth the great value of such a model. Different tiers of supports to be given can be assigned to different types of helpers, for example, volunteers can help to provide services such as massage, health assessment and answering medicine enquiries. However, for formal care, training is still needed, and the Comprehensive Service Vehicle should provide more resources to build up a trained team to provide community care services, such as home care services. The Comprehensive Service Vehicle model should be a financially sustainable elderly service, and its funding mode should be further explored. It is suggested a pilot scheme of

McGhee, S. M., Ho, L. M., Cheung, A. W. L., Abdullah, A. S. M., Chan, C. W. H., & Yeung, A. C. P. (2007). Evaluation of a mobile clinic for older people in Shamshuipo. Hong Kong Medical Journal, 13 (Supplement 1), S13â&#x20AC;&#x201C;15.

a mobile NEC on a vehicle should be conducted to test its acceptance by the elderly and the resource arrangement before deciding on the service charges.

7.2

Centre with Technology

7.2.1

A future centre — Testing future gerontech solutions

It is suggested to develop a gerontech development centre to assist the testing of gerontech products and localize the foreign gerontech products, so as to cater for the needs of the elderly and caregivers in Hong Kong. This development centre can further develop an elderly monitoring system to keep track of the health condition of the elderly (especially the physiological indicators) and monitor their home safety. The elderly monitoring system could also disseminate health information to the elderly, report the health condition of the elderly regularly to the clinics/hospitals (upon the elderly’s/caregivers’ consent), and provide alerts to caregivers and clinics/hospitals on emergency cases. The implementation of the elderly monitor system can start with a selective type of elderly, such as elderly singletons, elderly couples and elderly with impairments. 7.2.2

User-friendliness and awareness training on Gerontech for caregivers and the elderly: Assistive technology

The elderly can be categorized into different groups based on their attitude towards the use of technology, as some are early adopters, while some are hesitators. Though the elderly can learn the use of new technology from their children or grandchildren, peer influence will affect them more to become more open towards new technology. The majority of the elderly agreed that technology can make their lives easier, but some of them and even their caregivers are reluctant to adopt the new technology. Apart from their concerns about the costs, the perceived difficulties in using technology and the learning process to use technology are obstacles to their use. On the other hand, some of the elderly might have already learned how to use gerontech from their caregivers or through trainings. Thus they can become the “tutors” of other elderly, delivering the message that the elderly are never too old to learn technology. It is advisable to invite the elderly who are early adopters to become trainers/helpers and to promote the use of technology through their first-hand experience. However, technology is not the only solution. The efforts of professionals, like social workers, will remain the major support for the elderly.

The Senior Citizen Home Safety Association (SCHSA) is a pioneer in incorporating call and care services with technology to address the elderly’s needs, especially in emergency. The acceptance by the elderly is generally high. The SCHSA initiated the Smart Home for Seniors Pilot Programme,40 which aims at extending support for better ageing in place. The programme includes reducing chances of home accidents caused by wet bathroom floor and of fire from unattended cooking, and providing eHealth care and nurse care services. The success of the programme is due to different key factors: (1) the elderly’s awareness of the service, (2) the Association’s relationship with the groups of volunteers who have been providing call and care service as well as home visits, (3) the partnership with the Hospital Authority in providing follow-up medical care by sharing electronic medical records mutually, and (4) the continued improvements in the services or products provided. Looking ahead, to further promote ageing in place, the support for the elderly via technology use can be extended from emergency purpose and preventing home accidents to regular health monitoring purpose. The Jockey Club Community eHealth Care Project41 is one of the ongoing innovative projects which aims at fostering the elderly’s health by developing an eHealth Care system, collecting health data from 80 elderly centres in Hong Kong, reaching out to the elderly regularly by visits or calls provided by a professional multi-disciplinary team, and understanding more on the elderly’s health and life status so as to provide more activities to meet their needs. As the ageing population is increasing, it is expected that NECs would have a significant role to play in building and monitoring a remote health monitoring system. It is further suggested to establish a Smart Home and Smart Community culture among the elderly in Tai Po and the North District, which should be implemented in different phases. Also, in view of the findings of this study, addressing the need for technology of singletons and old-olds should be prioritized.

7.3 40 41

Caregiver Holiday

Senior Citizen Home Safety Association (2017, January). Smart Home for Seniors Pilot Programme. Retrieved from https://www.schsa.org.hk/en/services/smart_home/ index.html Hong Kong Jockey Club Charities Trust. (2019). Jockey Club Community eHealth Care Project. Retrieved from http://www.jc-ehealth.hk/en/index.html

The majority of the elderly do not like respite services because they do not like to be taken care of by others. They are only willing to be taken care of by their family members or significant others. Moreover, in view of the shortage of respite care services in Tai Po and the North District, there is a need to find a supplement worker to replace the elderly’s caregiver so as to give the caregiver some holidays.42 In one of the focus group interviews of this study, a daughter of an elderly with high support needs mentioned that she would like to have one day-off a week to relax and take a break. Supplement workers can be found at the neighbourhood level, usually the elderly’s neighbours or friends. They can work as temporary workers — only to take care of the elderly. This would provide a chance for the caregivers to have a day-off to recover from their exhaustion. With reference to the respite care service in Taiwan,43 which is called “gasp for breath service”, there are two types of respite care service, (1) provided by the government, and (2) provided by organizations/NGOs. The respite care service provided by the government is a home-based project. The eligible elderly should fulfil certain criteria before application, i.e., the caregiver should have taken care of the elderly for over one month, and the elderly should be 65 years old or above and needs assistance in IADL or depends on others to handle them.44 After the caregiver has applied for the respite service for the elderly, the government would then visit the elderly and conduct some assessments to decide his or her eligibility. The elderly with lower support needs can receive 14 days of respite care service per year and those with higher support needs can receive 21 days of respite care service per year. The duration of respite care service would be around six to eight hours per day. This provides a chance for the caregiver to take a break from taking care of the elderly twenty-four-seven. The charge of the respite service is around HK$300 per day, and the caregiver may receive subsidies from the government based on his/her financial situation. Full subsidies would be granted by the government for low income families.

香港政策研究所（ 2017 ）。《居家安老：家庭與社區的照顧及支援》。取自 http://www.hkpri.org.hk/storage/app/media/Research_Report/20170611_aging_in_place_report_web.pdf 林君黛、邱盈綺、徐宙玫、黃昱瞳（2013）。〈影響家庭照顧者使用機構喘息服務因素之探討〉。《澄清醫護管理雜誌》，9（3），7–14。 Ibid.

It is suggested the FYSK should utilize the space in the Cheung Lung Wai Centre to start providing respite services to the elderly and let their caregivers have the chance to take a rest. Further studies would be needed to explore this service mode in the future.

Chapter 8 CONCLUSION The objective of this study is to explore the needs of elderly singletons, elderly couples and caregivers for various community support services in Tai Po and the North District. We had invited elderly and caregiver members of the FYSK to answer questionnaire and participate in focus group discussions for this study. The questionnaire explored their opinions on current community support services, as well as their future needs for community support services. The focus group interviews explored the in-depth needs and opinions of the elderly singletons, couples as well as formal and informal caregivers. The profiles of the ageing population in Tai Po and the North District were found, as well as the health conditions of the elderly there. The majority of elderly singletons lack companions when visiting doctors. No family member was taking care of them. It was also found that there was an increasing trend of ageing caregivers. Elderly and caregiver members of the FYSK reported they were satisfied with the community recreational activities, community social activities, Elder Academy, outreach home visit service, elderly volunteer work, gerontech and tools, and physiological, psychological, and social health information offered to them. However, there were still some needs of the elderly which were yet to be satisfied, including home help services, cognitive training services, home care services, service matching and referral, counselling service, health and home care assessment, community rehabilitation service, financial management information, community meal/laundry service, and remote diagnostics and health consultation. The needs of caregivers should be another area to explore. Most of the caregivers were looking forward to a flexible mode of service to cater for the elderlyâ&#x20AC;&#x2122;s needs. A vast majority of caregivers agreed that community supports could also be provided by elderly volunteers. Caregivers also expected to have caregiver sharing and supportive activities, as well as additional information on their own social, physical and psychological health. To better cater for the needs of the elderly and caregivers, three service models had been suggested in order to assist the elderly and caregivers to â&#x20AC;&#x153;age in placeâ&#x20AC;?. A Comprehensive Service Vehicle was suggested to cater for the needs of the elderly in remote areas. The

proposed vehicle would serve as a mobile NEC and clinic to provide health information and medical service for the elderly in remote areas as they might have limited access to the NECs in the urban areas. Another service model proposed was to establish a technology centre, as technology had been penetrating into every aspect of our daily life. Gerontechnology should also be vastly developed in Hong Kong. It was further suggested that the FYSK could develop a centre to monitor the elderly’s health conditions and test gerontech products. The needs of caregivers should not be neglected as they play a vital role to ensure the health and safety of the elderly. The caregiver holiday was therefore suggested to let caregivers take a break from the exhaustion of taking care of the elderly. This model was in reference to the Taiwan’s caregiver holiday. Community service providers and the government should work hand in hand to provide a better environment for the elderly to “age in place” with the assistance of their caregivers, allowing the elderly and caregivers to have a fruitful and meaningful life.

APPENDIXES Table 1. Current needs by district Overall

Tai Po

North District

Community recreational activities

72.1%

82.4%

66.9%

Community social activities

65.2%

67.6%

63.9%

Elder Academy

44.1%

51.5%

40.0%

Outreach home visit service

38.6%

27.3%

43.6%

Participation in elderly volunteering

37.7%

28.3%

42.0%

Gerontech and tools

31.7%

24.8%

34.9%

Physiological, psychological, and social health information

31.0%

38.5%

27.5%

Home help service

17.7%

17.1%

18.2%

Cognitive training service

14.3%

14.1%

14.5%

Neighbourhood support/Respite service

13.2%

7.8%

15.9%

Home care services

12.6%

9.2%

14.3%

Service matching/Service referral for the elderly

11.9%

6.9%

14.3%

Counselling service

11.2%

9.3%

11.8%

Health and home care assessment

9.3%

7.0%

10.4%

Community rehabilitation service

9.0%

6.2%

10.4%

Financial management information

8.1%

7.9%

8.2%

Community meal/laundry service

7.7%

6.2%

8.6%

Remote diagnostics and health consultation

7.7%

3.1%

9.9%

Escort service

7.3%

7.8%

7.1%

Home rehabilitation services

6.6%

5.4%

7.2%

Transportation services for escort use

6.1%

4.7%

6.8%

Discharge support service

5.9%

4.7%

6.5%

Drug management

4.1%

6.2%

3.2%

Escort elderly in community activities/shopping

3.9%

* Note: 1. The figures in red were the top 10 most needed services. 2. A cell highlighted in orange means the service need was at least 5% more than the overall.

Table 2. Current needs by health status Overall

Excellent or very good

Good

Fair or poor

Community recreational activities

72.1%

69.5%

71.3%

72.6%

Community social activities

65.2%

64.4%

66.0%

64.6%

Elder Academy

44.1%

55.9%

46.8%

40.5%

Outreach home visit service

38.6%

39.7%

43.6%

36.7%

Participation in elderly volunteering

37.7%

49.2%

48.4%

31.4%

Gerontech and tools

31.7%

32.2%

27.4%

33.6%

Physiological, psychological, and social health information

31.0%

18.6%

28.3%

34.9%

Home help service

17.7%

8.5%

15.1%

20.7%

Cognitive training service

14.3%

11.9%

6.5%

17.8%

Neighbourhood support/Respite service

13.2%

10.2%

13.0%

14.2%

Home care services

12.6%

6.8%

6.5%

16.0%

Service matching/Service referral for the elderly

11.9%

10.2%

6.4%

14.5%

Counselling service

11.2%

10.2%

6.5%

13.3%

Health and home care assessment

9.3%

6.8%

6.5%

11.0%

Community rehabilitation service

9.0%

8.5%

5.4%

10.5%

Financial management information

8.1%

5.1%

4.3%

10.2%

Community meal/laundry service

7.7%

6.8%

5.4%

8.9%

Remote diagnostics and health consultation

7.7%

11.9%

3.3%

8.3%

Escort service

7.3%

5.1%

5.4%

8.6%

Home rehabilitation services

6.6%

3.4%

4.3%

8.2%

Transportation services for escort use

6.1%

5.1%

3.3%

7.4%

Discharge support service

5.9%

5.1%

2.2%

7.4%

Drug management

4.1%

6.8%

2.2%

4.3%

Escort elderly in community activities/shopping

3.9%

3.4%

1.1%

5.1%

* Note: 1. The figures in red were the top 10 most needed services. 2. A cell highlighted in orange means the service need was at least 5% more than the overall.

Table 3. Current needs by age group Overall

60â&#x20AC;&#x201C;69

70â&#x20AC;&#x201C;79

80 or above

Community recreational activities

72.1%

83.6%

76.6%

55.4%

Community social activities

65.2%

75.0%

70.6%

48.5%

Elder Academy

44.1%

55.7%

51.8%

22.4%

Outreach home visit service

38.6%

37.9%

42.3%

34.6%

Participation in elderly volunteering

37.7%

56.0%

37.1%

20.5%

Gerontech and tools

31.7%

19.5%

32.6%

41.1%

Physiological, psychological, and social health information

31.0%

33.6%

33.5%

24.2%

Home help service

17.7%

7.0%

23.1%

20.8%

Cognitive training service

14.3%

17.5%

16.8%

7.3%

Neighbourhood support/Respite service

13.2%

13.0%

15.5%

9.0%

Home care services

12.6%

4.3%

16.5%

15.2%

Service matching/Service referral for the elderly

11.9%

12.4%

13.5%

8.7%

Counselling service

11.2%

11.4%

13.5%

7.3%

Health and home care assessment

9.3%

7.0%

11.2%

8.1%

Community rehabilitation service

9.0%

7.9%

10.7%

6.5%

Financial management information

8.1%

10.5%

7.7%

5.6%

Community meal/laundry service

7.7%

6.1%

10.0%

4.8%

Remote diagnostics and health consultation

7.7%

7.1%

7.7%

7.5%

Escort service

7.3%

5.2%

8.9%

7.3%

Home rehabilitation services

6.6%

6.1%

4.8%

8.9%

Transportation services for escort use

6.1%

2.6%

9.5%

4.9%

Discharge support service

5.9%

3.5%

7.6%

4.9%

Drug management

4.1%

3.5%

4.8%

Escort elderly in community activities/shopping

3.9%

4.4%

4.1%

2.4%

* Note: 1. The figures in red were the top 10 most needed services. 2. A cell highlighted in orange means the service was at least 5% more than the overall.

Table 4. Current needs by living status Overall

Singleton

Couple only

Others

Community recreational activities

72.1%

71.0%

83.3%

70.3%

Community social activities

65.2%

64.8%

74.5%

62.9%

Elder Academy

44.1%

41.9%

55.3%

43.6%

Outreach home visit service

38.6%

46.0%

40.4%

28.2%

Participation in elderly volunteering

37.7%

39.1%

42.6%

34.4%

Gerontech and tools

31.7%

41.1%

27.1%

20.0%

Physiological, psychological, and social health information

31.0%

33.2%

20.8%

31.2%

Home help service

17.7%

23.0%

18.8%

10.3%

Cognitive training service

14.3%

13.6%

12.8%

15.6%

Neighbourhood support/Respite service

13.2%

15.0%

19.1%

9.1%

Home care services

12.6%

16.2%

8.3%

9.0%

Service matching/Service referral for the elderly

11.9%

13.3%

8.3%

11.1%

Counselling service

11.2%

14.4%

6.4%

8.3%

Health and home care assessment

9.3%

10.1%

6.4%

9.0%

Community rehabilitation service

9.0%

10.1%

8.5%

7.7%

Financial management information

8.1%

7.8%

4.3%

9.6%

Community meal/laundry service

7.7%

7.1%

10.6%

7.7%

Remote diagnostics and health consultation

7.7%

7.3%

12.8%

6.6%

Escort service

7.3%

9.1%

0.0%

7.1%

Home rehabilitation services

6.6%

7.7%

4.3%

5.8%

Transportation services for escort use

6.1%

6.7%

0.0%

7.1%

Discharge support service

5.9%

7.7%

2.1%

4.5%

Drug management

4.1%

3.8%

6.4%

3.8%

Escort elderly in community activities/shopping

3.9%

4.3%

0.0%

4.5%

* Note: 1. The figures in red were the top 10 most needed services. 2. A cell highlighted in orange means the service need was at least 5% more than the overall.

Table 5. Current needs by education attainment

Overall

No schooling or pre-schoolin g

Primary school

Secondary school

Community recreational activities

72.1%

66.1%

74.5%

79.3%

Community social activities

65.2%

59.3%

69.7%

67.8%

Elder Academy

44.1%

35.2%

45.7%

58.1%

Outreach home visit service

38.6%

38.4%

40.6%

35.3%

Participation in elderly volunteering

37.7%

23.8%

44.1%

52.3%

Gerontech and tools

31.7%

42.9%

22.7%

26.7%

Physiological, psychological, and social health information

31.0%

26.7%

31.9%

37.5%

Home help service

17.7%

22.4%

12.4%

18.6%

Cognitive training service

14.3%

12.3%

14.5%

17.6%

Neighbourhood support/ Respite service

13.2%

13.5%

10.1%

18.6%

Home care services

12.6%

15.2%

9.9%

12.8%

Service matching/Service referral for the elderly

11.9%

10.8%

11.9%

14.1%

Counselling service

11.2%

9.7%

11.2%

14.1%

Health and home care assessment

9.3%

11.5%

6.9%

9.4%

Community rehabilitation service

9.0%

9.7%

9.4%

7.1%

Financial management information

8.1%

4.9%

10.0%

10.6%

Community meal/laundry service

7.7%

7.3%

4.9%

14.0%

Remote diagnostics and health consultation

7.7%

6.2%

8.1%

9.6%

Escort service

7.3%

6.7%

6.8%

9.3%

Home rehabilitation services

6.6%

7.3%

7.5%

3.5%

Transportation services for

6.1%

5.5%

6.2%

7.0%

Overall

No schooling or pre-schoolin g

Primary school

Secondary school

Overall

No schooling or pre-schoolin g

Primary school

Secondary school

Discharge support service

5.9%

4.3%

6.2%

8.2%

Drug management

4.1%

4.8%

3.7%

3.5%

Escort elderly in community activities/shopping

3.9%

3.0%

5.6%

2.3%

escort use Table 5 (Continued)

* Note: 1. The figure in red were the top most needed services. 2. A cell highlighted in orange means the service need was at least 5% more than the overall.

Table 6. Future needs by district Overall

Tai Po

North District

Home care services

50.1%

60.0%

45.4%

Home help service

43.9%

55.8%

38.6%

Service matching/Service referral for the elderly

43.2%

57.7%

36.6%

Remote diagnostics and health consultation

41.5%

52.3%

36.5%

Discharge support service

41.0%

51.9%

36.0%

Transportation services for escort use

40.2%

52.7%

34.5%

Home rehabilitation services

39.1%

48.8%

34.7%

Escort service

37.1%

48.1%

32.1%

Community rehabilitation service

36.8%

48.8%

31.3%

Gerontech and tools

36.7%

51.1%

29.9%

Health and home care assessment

36.6%

45.7%

32.4%

Community meal/laundry service

36.3%

45.4%

32.1%

Escort elderly in community activities/shopping

36.3%

47.3%

31.2%

Drug management

35.9%

41.1%

33.6%

Counselling service

31.6%

40.3%

27.6%

Cognitive training service

31.4%

39.1%

27.9%

Neighbourhood support/Respite service

29.4%

38.3%

25.3%

Physiological, psychological, and social health information

28.1%

28.5%

27.9%

Financial management information

25.7%

28.3%

24.7%

Outreach home visit service

20.3%

30.3%

15.7%

Participation in elderly volunteering

16.5%

28.3%

11.0%

Elder Academy

16.0%

16.2%

16.1%

Community social activities

10.7%

13.2%

9.3%

Community recreational activities

7.1%

6.6%

7.5%

* Note: 1. The figures in red were the top 10 most needed services. 2. A cell highlighted in orange means the service need was at least 5% more than the overall.

Table 7. Future needs by health status Overall

Excellent or very good

Good

Fair or poor

Home care services

50.1%

54.2%

40.9%

52.9%

Home help service

43.9%

54.2%

31.2%

46.5%

Service matching/Service referral for the elderly

43.2%

50.8%

31.9%

45.5%

Remote diagnostics and health consultation

41.5%

40.7%

28.6%

46.8%

Discharge support service

41.0%

42.4%

25.0%

46.9%

Transportation services for escort use

40.2%

40.7%

29.3%

44.1%

Home rehabilitation services

39.1%

39.0%

26.1%

44.3%

Escort service

37.1%

35.6%

26.9%

41.2%

Community rehabilitation service

36.8%

39.0%

25.0%

41.0%

Gerontech and tools

36.7%

37.3%

26.3%

40.2%

Health and home care assessment

36.6%

39.0%

23.7%

41.2%

Community meal/laundry service

36.3%

39.0%

26.9%

39.5%

Escort elderly in community activities/shopping

36.3%

39.0%

24.7%

40.1%

Drug management

35.9%

33.9%

23.7%

41.2%

Counselling service

31.6%

27.1%

24.7%

35.5%

Cognitive training service

31.4%

30.5%

22.8%

35.2%

Neighbourhood support/Respite service

29.4%

30.5%

17.4%

33.5%

Physiological, psychological, and social health information

28.1%

35.6%

22.8%

28.3%

Financial management information

25.7%

23.7%

22.8%

26.7%

Outreach home visit service

20.3%

20.7%

13.8%

22.8%

Participation in elderly volunteering

16.5%

18.6%

8.8%

19.0%

Elder Academy

16.0%

8.5%

12.8%

19.1%

Community social activities

10.7%

10.2%

10.6%

11.0%

Community recreational activities

7.1%

8.5%

6.4%

7.2%

* Note: 1. The figures in red were the top 10 most needed services. 2. A cell highlighted in orange means the service need was at least 5% more than the overall.

Table 8. Future needs by age group Overall

60â&#x20AC;&#x201C;69

70â&#x20AC;&#x201C;79

80 or above

Home care services

50.1%

58.3%

47.6%

45.6%

Home help service

43.9%

53.0%

39.1%

41.6%

Service matching/Service referral for the elderly

43.2%

44.2%

45.9%

38.1%

Remote diagnostics and health consultation

41.5%

46.0%

43.2%

35.8%

Discharge support service

41.0%

43.9%

42.4%

37.4%

Transportation services for escort use

40.2%

42.6%

39.6%

39.0%

Home rehabilitation services

39.1%

43.0%

42.3%

32.3%

Escort service

37.1%

39.1%

34.7%

Community rehabilitation service

36.8%

41.2%

37.9%

32.3%

Gerontech and tools

36.7%

46.0%

37.2%

27.1%

Health and home care assessment

36.6%

41.2%

37.3%

32.3%

Community meal/laundry service

36.3%

44.3%

33.5%

33.6%

Escort elderly in community activities/shopping

36.3%

38.6%

37.1%

33.9%

Drug management

35.9%

37.4%

38.2%

31.5%

Counselling service

31.6%

37.7%

32.4%

25.8%

Cognitive training service

31.4%

33.3%

31.1%

30.9%

Neighbourhood support/Respite service

29.4%

35.7%

29.8%

23.8%

Physiological, psychological, and social health information

28.1%

33.6%

27.6%

24.2%

Financial management information

25.7%

32.5%

26.2%

19.4%

Outreach home visit service

20.3%

24.1%

20.2%

17.3%

Participation in elderly volunteering

16.5%

19.8%

16.5%

13.9%

Elder Academy

16.0%

23.5%

12.9%

13.6%

Community social activities

10.7%

13.8%

10.6%

8.5%

Community recreational activities

7.1%

7.8%

7.0%

6.9%

* Note: 1. The figures in red were the top 10 most needed services. 2. A cell highlighted in orange means the service need was at least 5% more than the overall.

Table 9. Future needs by living status Overall

Singleton

Couple only

Others

Home care services

50.1%

51.0%

43.8%

51.0%

Home help service

43.9%

42.6%

35.4%

48.4%

Service matching/Service referral for the elderly

43.2%

38.9%

50.0%

47.1%

Remote diagnostics and health consultation

41.5%

42.2%

44.7%

39.5%

Discharge support service

41.0%

42.3%

48.9%

36.8%

Transportation services for escort use

40.2%

46.8%

38.3%

Home rehabilitation services

39.1%

40.6%

44.7%

35.5%

Escort service

37.1%

38.3%

42.6%

34.0%

Community rehabilitation service

36.8%

36.1%

42.6%

36.1%

Gerontech and tools

36.7%

28.5%

50.0%

43.9%

Health and home care assessment

36.6%

37.5%

44.7%

32.9%

Community meal/laundry service

36.3%

38.6%

38.3%

32.7%

Escort elderly in community activities/shopping

36.3%

36.8%

44.7%

32.9%

Drug management

35.9%

37.3%

42.6%

32.1%

Counselling service

31.6%

30.8%

36.2%

31.4%

Cognitive training service

31.4%

32.5%

36.2%

28.6%

Neighbourhood support/Respite Service

29.4%

26.1%

34.0%

32.5%

Physiological, psychological, and social health information

28.1%

28.8%

35.4%

24.8%

Financial management information

25.7%

24.8%

29.8%

25.6%

Outreach home visit service

20.3%

16.1%

23.4%

25.0%

Participation in elderly volunteering

16.5%

15.5%

14.9%

18.5%

Elder Academy

16.0%

15.7%

12.8%

17.3%

Community social activities

10.7%

10.8%

8.5%

11.3%

Community recreational activities

7.1%

7.0%

2.1%

8.9%

* Note: 1. The figures in red were the top 10 most needed services. 2. A cell highlighted in orange means the service need was at least 5% more than the overall.

Table 10. Future needs by education attainment Overall

No schooling or pre-schooling

Home care services

50.1%

43.6%

53.7%

55.8%

Home help service

43.9%

37.6%

50.9%

43.0%

Service matching/Service referral for the elderly

43.2%

41.9%

42.5%

47.1%

Remote diagnostics and health consultation

41.5%

42.6%

37.5%

47.0%

Discharge support service

41.0%

42.7%

40.4%

38.8%

Transportation services for escort use

40.2%

39.3%

42.9%

37.2%

Home rehabilitation services

39.1%

40.2%

35.6%

43.5%

Escort service

37.1%

37.2%

38.3%

34.9%

Community rehabilitation service

36.8%

35.8%

36.9%

38.8%

Gerontech and tools

36.7%

29.8%

39.3%

45.3%

Health and home care assessment

36.6%

36.4%

36.3%

37.6%

Community meal/laundry service

36.3%

32.1%

42.6%

32.6%

Escort elderly in community activities/shopping

36.3%

35.8%

37.5%

34.9%

Drug management

35.9%

35.8%

37.3%

33.7%

Counselling service

31.6%

32.7%

30.4%

31.8%

Cognitive training service

31.4%

34.4%

28.9%

30.6%

Neighbourhood support/Respite Service

29.4%

28.8%

31.4%

26.7%

Physiological, psychological, and social health information

28.1%

29.1%

28.1%

26.1%

Financial management information

25.7%

22.6%

25.0%

32.9%

Outreach home visit service

20.3%

17.1%

20.6%

25.9%

Participation in elderly volunteering

16.5%

14.6%

18.0%

17.4%

Primary Secondary school school

Table 10 (Continued) Overall

No schooling or pre-schooling

Elder Academy

16.0%

13.9%

17.9%

16.3%

Community social activities

10.7%

13.2%

7.9%

11.5%

Community recreational activities

7.1%

6.5%

7.9%

6.9%

Primary Secondary school school

* Note: 1. The figures in red were the top 10 most needed services. 2. A cell highlighted in orange means the service need was at least 5% more than the overall.

Table 11. Caregiversâ&#x20AC;&#x2122; needs Have need

Might need in the future

No need

Donâ&#x20AC;&#x2122;t know

Health knowledge of elderly

61.1%

17.2%

19.7%

2.0%

Health information of elderly (e.g. Health care voucher, community care service)

57.1%

14.1%

27.3%

1.5%

Caregiver sharing and supportive activities

52.0%

19.2%

28.3%

0.5%

Social health information for caregiver

46.5%

20.7%

30.8%

2.0%

Physical health information for caregiver

41.4%

29.8%

27.8%

1.0%

Psychological health information for caregiver

40.4%

28.3%

30.3%

1.0%

Caregiving courses and education

37.9%

27.3%

34.3%

0.5%

Outreach home visit service

28.8%

22.7%

47.5%

1.0%

Elderly volunteering services

25.3%

26.3%

46.5%

2.0%

Drug management information

23.2%

33.3%

42.4%

1.0%

Demonstration and leasing of rehabilitation equipment

22.7%

40.4%

35.9%

1.0%

Gerontech and tools

22.2%

40.4%

35.4%

2.0%

Counselling service

18.2%

27.8%

52.0%

2.0%

Service matching/Service referral for the elderly

14.1%

35.9%

46.5%

3.5%

Remote diagnostics and health consultation

13.1%

35.4%

49.0%

2.5%

Escort caregivers to the elderly home

12.6%

36.9%

48.0%

2.5%

Residential respite service for the elderly

12.1%

33.3%

53.0%

1.5%

Neighbourhood support/respite service (e.g. child care)

9.6%

30.3%

58.1%

2.0%

Others

3.3%

2.2%

12.8%

81.7%

* Note: 1. The figures in red were the top 10 most needed services.

Table 12. Elderlyâ&#x20AC;&#x2122;s awareness of community service Have need

Might need in the future

No need

Donâ&#x20AC;&#x2122;t know

Health knowledge of elderly

61.1%

17.2%

19.7%

2.0%

Health information of elderly (e.g. Health care voucher, community care service)

57.1%

14.1%

27.3%

1.5%

Caregiver sharing and supportive activities

52.0%

19.2%

28.3%

0.5%

Social health information for caregiver

46.5%

20.7%

30.8%

2.0%

Physical health information for caregiver

41.4%

29.8%

27.8%

1.0%

Psychological health information for caregiver

40.4%

28.3%

30.3%

1.0%

Caregiving courses and education

37.9%

27.3%

34.3%

0.5%

Outreach home visit service

28.8%

22.7%

47.5%

1.0%

Elderly volunteering services

25.3%

26.3%

46.5%

2.0%

Drug management information

23.2%

33.3%

42.4%

1.0%

Demonstration and leasing of rehabilitation equipment

22.7%

40.4%

35.9%

1.0%

Gerontech and tools

22.2%

40.4%

35.4%

2.0%

Counselling service

18.2%

27.8%

52.0%

2.0%

Service matching/Service referral for the elderly

14.1%

35.9%

46.5%

3.5%

Remote diagnostics and health consultation

13.1%

35.4%

49.0%

2.5%

Escort caregivers to the elderly home

12.6%

36.9%

48.0%

2.5%

Residential respite service for the elderly

12.1%

33.3%

53.0%

1.5%

Neighbourhood support/respite service (e.g. child care)

9.6%

30.3%

58.1%

2.0%

Others

3.3%

2.2%

12.8%

81.7%

* Note: 1. The figures in red were the top 10 most needed services.

Elderly’s Questionnaire Study on the needs of elderly singletons, elderly couples, and caregivers for various community support services in Tai Po and the North District (Elderly’s Questionnaire) Part 1

Health Condition

We would like to know about your health condition. Please answer the following questions about your health condition. Q1. Have you ever been diagnosed with the following chronic diseases or disabilities? (You can choose more than one option.) 1 3

□ High blood pressure □ Diabetes

2 4

□ Chronic respiratory disease (such as bronchitis, asthma) □ Stroke □ Hearing impairment (such as tinnitus, deaf) □ Physically handicapped □ Cutaneous condition □ Other mental illness □ Others, please specify:______

7 9 11 13 15 17

□ Hypercholesterolemia □ Joint disease (such as arthritis, metabolic arthritis, osteoporosis) □ Dementia

8 □ Heart disease 10 □ Eye disease (such as cataract, glaucoma) 12 □ Cancer (Please specify:_____) 14 □ Depression 16 □ Disease of the nervous system 18 □ None of the above

Q2. Do you need long-term prescription? 1

□ Yes

□ No

Q3. Have you been admitted to the hospital in the past 12 months (not including body check)? 1

□ Yes, number of time(s):_____

□ No

Q4. Did you have medical consultation due to sickness last month (not including body check)? 1

□ Yes, number of time(s):_____

□ No (Skip to Q6)

Q5. Does anyone escort you to medical consultation? 1

□ Yes, the person(s) who escort me is/are:

(You can choose more than one option.) a. □ Spouse c. □ Son-in-law or daughter-in law e. □ Grandchild-in-law g. □ Brother or sister i. □ Relative of the same generation k. □ Friend m. □ Local domestic helper o. □ Escort service provider q. □ Others, please specify:________ 2

b. d. f. h. j. l. n. p.

□ Son or daughter □ Grandchild □ Father or mother □ Relative of the older generation □ Relative of the younger generation □ Neighbour □ Foreign domestic helper □ Volunteer (including elderly volunteer)

□ No

Q6. Activities of Daily Living (ADL)45 Are you able to do the following daily activities on your own? (Please put a “” in the appropriate space.) Daily activities 1

Personal hygiene (e.g., bathing, cleaning the body)

Wearing clothes

Going to toilet

Bowel and urination control

Going into and out of bed

Eating

Can do on your own (1)

Cannot do on your own (0)

Divided into grades 1 to 4, based on the number of self-care activities that cannot be done independently (including going into and out of bed, walking, wearing clothes, eating, going to toilet and bathing.). See Shelkey, M., & Wallace, M. (1999). Katz index of independence in activities of daily living. Journal of Gerontological Nursing, 25(3), 8-–9.

Please choose the most appropriate statement that describes your activities of daily living according to your situation in the last month. Activities of daily living 7

Ability to use the telephone □ (1) Can use the telephone on your own, including dealing numbers, looking up the telephone directory, etc. □ (2) Can dial familiar telephone numbers. □ (3) Can answer telephone calls but cannot dial out. □ (4) Cannot use the telephone at all.

Shopping □ (1) Can go to shopping anywhere independently. □ (2) Can only make small purchases of daily independently daily commodities. □ (3) Need to be accompanied for each shopping. □ (4) Completely unable to shop independently.

Preparing food □ (1) Can plan and cook a proper meal independently. □ (2) Can cook a proper meals if the ingredients are prepared beforehand. □ (3) Can reheat the meals to eat. □ (4) Need other people to prepare and serve the meals.

10 Housework (e.g., sweeping floor, washing dishes) □ (1) Can do heavy housework (e.g., wiping floor and windows) independently or with occasional assistance. □ (2) Can do simple housework (e.g., washing dishes, making beds) independently. □ (3) Can do simple housework independently but cannot reach an acceptable level of tidiness. □ (4) Need help with all housework. □ (5) Cannot do any housework. 11 Taking medicine □ (1) Can take the correct medicine in the correct dosage at the correct time independently. □ (2) Can take the medicine independently if the dosage of the medicine is prepared in advance. □ (3) Cannot take the medication independently. 12 Ability to handle finances (e.g., paying bills, going to bank)

□ (1) Can manage my own financial matters independently, and have control over the status of income and expenditure. □ (2) Can manage day-to-day expenses, but need help with banking and large amount transactions. □ (3) Incapable of handling money. 13 Laundry □ (1) Can do the laundry independently. □ (2) Can do the laundry of small items. □ (3) All laundry must be done by others. 14 Mode of Transportation □ (1) Can travel independently using public transportation or drive my own car. □ (2) Can travel independently on taxi, but do not use other public transportation. □ (3) Can travel on public transportation when accompanied by other people. □ (4) Need other people’s assistance to take taxi or ride in car. □ (5) Do not go out at all.

Q7. How would you rate your health condition overall? 1 □ Extremely well

2 □ Very

3 □ Good

good

4 □ Average

5 □ Poor

Part 2

Information about the informal caregivers

Q8. Is there any family member taking care of you (including family members living or not living with you) ? 1

□

Yes, no. of persons _____

□

Q9. Information about the major caregiver(s) (based on the duration of care)

Your relationship to the caregiver 1 Spouse or partner 2 Son or daughter 3 Son-in-law or daughter-in-law 4 Grandchild 5 Grandchild-in-law 6 Father or mother 7 Brother or sister 8 Relative of the older generation 9 Relative of the same generation 10 Relative of the younger generation 11 Friend 12 Neighbour 13 Local domestic helper 14 Foreign domestic helper 15 Others, please specify: _________________________________

Gender 1 Male

Female

Age (please write in the box) 0 Don’t know 999 Refuse to answer

No. of days giving care per week on average 999 Refuse to answer

No. of hours giving care per day on average

1st caregiver

2nd caregiver

999 Refuse to answer f.

Whether he/she lives with you 1 Most of the time (4 days or more a week on average) 2 Occasionally or when needed 3 Not living with me

Occupation of the caregiver 1 Full-time employee 2 Part-time/casual work employee 3 Self-employed 4 Employer 5 Housekeeper 6 Retired 7 Unemployed/Waiting for employment 8 Resigned from work due to caregiving 9 Donâ&#x20AC;&#x2122;t know

To what extent do you think the caregiver could help you? 1 Very much 2 Moderately 3 A little 4 Not at all

1st caregiver

2nd caregiver

Part 3

Use of formal caregiving services

Q10. Do you know the following residential care services or community care services? If you know the service(s), have you applied for/used the services in the past year? (Please put a ‘’in the appropriate space.) Service Type

III

Whether you Whether you know the have applied services for the services Yes

Yes#

No*

Yes#

No*

(1)

(2)

(3)

(4)

(5)

(6)

Residential Care Services a.

Homes for the Aged/Care and Attention Homes for the Elderly/Nursing Homes/Contract Homes

Hostels for the Elderly

Emergency Placement Service

Residential Respite Service for the Elderly

The Pilot Scheme on Residential Care Service Voucher for the Elderly

Community Care Services f.

District Elderly Community Centre

Neighbourhood Elderly Centre

Day Care Centre

Day Respite Service for Elderly Persons

Integrated Home Care Services (such as Home Help Service)

Enhanced Home and Community Care Services

Whether you have used the services

Service Type

III

Whether you Whether you know the have applied services for the services

Whether you have used the services

Yes

Yes#

No*

Yes#

No*

(1)

(2)

(3)

(4)

(5)

(6)

Second Phase of the Pilot Scheme on Community Care Service Voucher for the Elderly

Other Services m. Integrated Discharge Support Programme for Elderly Patients n.

Not sure about the service type

Others, please specify:_______

* If you have not applied for/used the residential care services or community care services (of types a to m), please skip to answer Q11. # If you have used the residential care services or community care services, please answer Q12 to Q18.

Q11.

(For the elderly who have not used/applied the for the residential care services or community care services.) Why did you not use/apply for the residential care services or community care services? (You can choose more than one option.)

□

3 5 7 9

□ □ □ □

11 □

Not know about the service details Inconvenient service location High cost Poor service quality Application rejected

□

4 6 8 10

□ □ □ □

Have no information of how to apply Long waiting time Complicated application procedure Wishing to “age in place” Do not need community support services (e.g., being able to take care of oneself, being taken care of by family members)

Others, please specify: ___________________________________________

Q12. Who gave you information about the community care services that you are using? (You can choose more than one option.) 1 3

□ □

5 7

□ □

□

11 □ 13 □ 15 □

Spouse Son-in-law or daughter-in-law Grandchild-in-law Brother or sister

2 4

□ □

Son or daughter Grandchild

6 8

□ □

Other relatives of the same generation Friends Local domestic helper Others, please specify: _______________________

10 □

Father or mother Other relatives of an older generation Other relatives of a younger generation Neighbours Foreign domestic helper Not applicable

12 □ 14 □ 0 □

Q13. From where do you know the information about the community care services that you are using? (You can choose more than one option.) 1

□

Hospital/Clinic

□

District Elderly Community Centre/Neighbourhood Elderly Centre/Day Care Centre

3 5 7 0

□ □ □ □

TV/Radio advertisements Internet (e.g., email, forum) Letter Not applicable

4 6 8

□ □ □

Leaflets/Posters SMS Others, please specify:_________

Q14. If you use the community care services, what service(s) do you use? (You can choose more than one option.) 1 3 5

□ □ □

7 9

□ □

11 □

Escort service Meal delivery service Personal care service (e.g., bathing, cleaning) Elderly volunteering Recreational service

2 4 6

□ □ □

8 □ 10 □

Cleaning service Counselling service Home care service Volunteering service Rehabilitation service

Others, please specify:____________________________________________

Q15. How long have you been using the community care services? 1 3 5

□ □ □

Less than a month Four to six months Ten to twelve months

2 4 6

One to three months Seven to nine months Over twelve months

□ □ □

Q16. To what extent do you think the community care services could help you? 1 3

□ □

Very much A little

2 4

Moderately Not at all

□ □

Q17. Are you satisfied with the current community care services? 1 2

□ □

Yes No, because: (You can choose more than one option) a. □ High cost b. □ Low professionalism of c. e. g. i.

□ □ □ □

d. □ Poor attitude of staff Inconvenient service location f. □ h. □ Not flexible service hours Others, please specify:___________

staff Long waiting time Poor environment Complicated application procedure

Q18. How do you think the community care services that you are currently using can be improved? (You can choose more than one option.) (The interviewer has to read out all the options.) 1 3

□ □

□

11 □ 13 □ Part 4

Lower the cost Increase the staff of community care services Improve the service attitude of the community care services staff Increase the facilities of community care services Have more flexible service hours

2 4

□ □

□

Enhance the recreational service Others, please specify:_______

12 □ 14 □

10 □

The needs of the elderly

Increase the escort service Raise the professionalism of the community care services staff Improve the environment of the community care services Strengthen the caregiving/ rehabilitation services Have more flexible service arrangement Enhance the counselling service No idea

Q19. To what extent do you think you need the following elderly community care service now? If you are in need, can the current services satisfy your needs? (The interviewer has to use the display cards.) I. To what extent does the elderly

II. If needed,

need the community care service

whether the current community care service can satisfy the needs (answer 2, 3, or 4 in Part I) Satisfied (1)

Not satisfied (2)

N.A.(777)

(Do not give any hint)

Do not know (9)

□（777）

Home help service

□（0） □（1） □（2） □（3） □（4） □（9）

□（1）

□（2）

□（777）

Physiological, psychological, and social health information

□（0） □（1） □（2） □（3） □（4） □（9）

□（1）

□（2）

□（777）

Financial management information

□（0） □（1） □（2） □（3） □（4） □（9）

□（1）

□（2）

□（777）

Elder Academy

□（0） □（1） □（2） □（3） □（4） □（9）

□（1）

□（2）

□（777）

Community social activities

□（0） □（1） □（2） □（3） □（4） □（9）

□（1）

□（2）

□（777）

Community recreational activities

□（0） □（1） □（2） □（3） □（4） □（9）

□（1）

□（2）

□（777）

Participation in elderly volunteering

□（0） □（1） □（2） □（3） □（4） □（9）

□（1）

□（2）

□（777）

Outreach home visit service

□（0） □（1） □（2） □（3） □（4） □（9）

□（1）

□（2）

□（777）

Neighbourhood □（0） □（1） □（2） □（3） □（4） □（9） support/Respite service

□（1）

□（2）

□（777）

Community meal/laundry service

□（1）

□（2）

□（777）

Always (4)

□（2）

Usually (3)

□（1）

Occasionally (2)

□（0） □（1） □（2） □（3） □（4） □（9）

No need now, may need in the future (1)

Home care service

No need (0)

□（0） □（1） □（2） □（3） □（4） □（9）

I. To what extent does the elderly

need the community care service

II. If needed,

whether the current community care service can satisfy the needs (answer 2, 3, or 4 in Part I) Satisfied (1)

Not satisfied (2)

N.A.(777)

(Do not give any hint) Do not know (9)

□（2）

□（777）

Transportation services □（0） □（1） □（2） □（3） □（4） □（9） for escort use (e.g., Rehab bus, Access cars, Dial-a-ride service)

□（1）

□（2）

□（777）

Escort elderly in community activities/shopping

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Counselling service

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Cognitive training service

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Community rehabilitation service

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Home rehabilitation service

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Health and home care assessment

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Discharge support service

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Tele-consultation and health consultation

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Always (4)

□（1）

Usually (3)

□（0） □（1） □（2） □（3） □（4） □（9）

Occasionally (2)

□（777）

No need now, may need in the future (1)

□（2）

No need (0)

□（1）

Drug management (e.g. □（0） □（1） □（2） □（3） □（4） □（9） drug guidance, drug injection and dressing service)

m Escort service

I. To what extent does the elderly

II. If needed,

need the community care service

Not satisfied (2)

N.A.(777)

Satisfied (1)

(Do not give any hint)

Service matching/Service referral for the elderly

Do not know (9)

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Always (4)

□（777）

Usually (3)

□（2）

Occasionally (2)

(e.g., smart medicine box, personal emergency link service, health monitoring tools, smart rehabilitation tools)

No need now, may need in the future (1)

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

No need (0)

w Gerontech and tools

whether the current community care service can satisfy the needs (answer 2, 3, or 4 in Part I)

Q20. If your district community centre could arrange mobile clinic in your community, what service(s) do you want to have? (You can choose more than one option.) 1 3

□ □

5 7

□ □

□

Chinese medical consultation Massage, treatment, and acupuncture Health assessment Medicine enquiries and management Referral service

2 4

□ □

Western medical consultation Rehabilitation activities

6 8

□ □

Mental health assessment Disease prevention

10 □

Other services:____________

Q21. Have you ever used the escort vehicle? 1

□

Yes  Skip to Q22

□

No  Skip to Q24

Q22. How much did you spend on using escort vehicles in the past month?

HK$ _______________ Q23. According to your past experience in using escort vehicles, how much was the cost of the escort vehicle per hour? 1 3 5 7 9 11

□ □ □ □ □ □

2 4 6 8 10 0

Below $60 $80 $100 $120 $140 More than $150 (please specify:_____)

□ □ □ □ □ □

$70 $90 $110 $130 $150 Forgotten

Q24. If your district community centre could provide the escort vehicle service in your community, will you use it? 1

□

Yes  Skip to Q25

□

No  Skip to Q26

Q25. How much do you think is reasonable for using the escort vehicle service per hour? 1 3 5 7 9 11

□ □ □ □ □ □

Free $70 $90 $110 $130 $150

2 4 6 8 10 12

□ □ □ □ □ □

Below $60 $80 $100 $120 $140 More than $150 (please specify:______)

Q26. Do you need other community support services? If yes, please state the community support services you need. _____________________________________________________________________________ _____________________________________________________________________________

Part 5

Quality of life of the elderly

The following questions ask about your level of satisfaction with your overall quality of life. Please choose the most appropriate answers based on your condition in the last two weeks. Overall quality of life Q27. How would you rate your quality of life? 1□ Very poor 2□ Poor

3□ Average 4□ Good 5□ Very good

Health condition Q28. How satisfied are you with your health? 1 □ Very dissatisfied 4 □ Satisfied

2 □ Dissatisfied 5 □ Very satisfied

3 □ Neither satisfied nor dissatisfied

Q29. In the scale of 0–10, “0” means very unhappy, “10” means very happy, how happy are you? (Please circle the appropriate answer.) Very

Very

unhappy

Average

happy

Part 6

Basic information

Q30. Age: _____________ years old (If the respondent refused to answer the actual age, please select the appropriate age group below.) 1 4

□ □

60–64 75–79

2 5

□ □

65–69 ≥80

□

70–74

Q31. Gender 1

□

Male

□

Female

Q32. Years living in Hong Kong 1 3

□ □

2 □ 999 □

_____________ years Forgotten

Since birth Refused to answer

Q33. Marital status 1 4

□ □

Married Separated

2 5

□ □

Cohabitation Widowed

3 6

□ □

Divorced Never married

Q34. Education level 1 2 3 4

□ □ □ □

No schooling/Pre-primary education Primary school Secondary school Post-secondary education or above

Q35. Living arrangement 1 2 3 4 5

□ □ □ □ □

Living with my spouse and my son(s) and/or daughter(s) Living with my spouse, but not with my son(s) and/or daughter(s) Living with my son(s) and/or daughter(s) only Living alone Others, please specify:________________

Q36. Area of Residence 1 3 5

□ □ □

2 □ Tai Po – Urban district Tai Po – Rural district 4 □ North Distract– Urban district North District – Rural district Others, please specify:____________________________________________

Q37. Transportation a. The public transport that you usually use is/are: (You can choose more than one option.) 1 □ 4 □ 7 □

On foot, no public transport needed Bus Rehab bus

2 □

MTR

3 □

5 □ 8 □

6 □ Private car Taxi Others, please specify:___________________

Minibus

Using your usual travelling method, how long does it take for you to get to your nearest elderly centre?

1 3

□ □

Using your usual travel method, how long does it take to get to your nearest medical services?

1 3

□ □

2 4

Less than 30 minutes 45 minutes to 1 hour

2 4

Less than 30 minutes 45 minutes to 1 hour

□ □

30–45 minutes More than 1 hour

30-45 minutes More than 1 hour

Q38. Do you receive the following government subsidies? (You can choose more than one option) 1

□

Comprehensive Social Security Assistance (CSSA) Scheme

□

Old Age Living Allowance

3 4 5 6 7 8 9 10 0 999

□ □ □ □ □ □ □ □ □ □

Old Age Allowance Health Care Voucher Normal Disability Allowance Higher Disability Allowance Community Care Fund – Dementia Community Support Scheme Community Care Fund – Elderly Dental Assistance Programme Others, please specify:________________________________________ None of the above Don’t know Refused to answer

- End -

Caregiver’s Questionnaire Study on the needs of elderly singletons, elderly couples, and caregivers for various community support services in Tai Po and the North District (Caregiver’s Questionnaire) Part 1

Information about the elderly

Q1. Currently taking care of _____ (number) elderly

Female

Q3. Your relationship to the elderly 1

Spouse

Father or mother

Parents of spouse

Grandfather or grandmother

Grandfather or grandmother of spouse

Brother or sister

Relative of the older generation

Relative of the same generation

Friend

Neighbour

Others, please specify:________________________

Q4. Age of the elderly (please write in the box) Select the following options if you do not know the age. 1

60–64

65–69

70–74

75–79

≥80

4th elderly

Male

3rd elderly

2nd elderly

Q2. Gender of the elderly

1st elderly

(Please write down the answer in the appropriate box. If the respondent refuse to answer, please write “999”, if the answer is unknown, please write “777”.)

Primary school

Secondary school

Post-secondary education or above

Q6. Marital status of the elderly 1

Married

Cohabitation

Divorced

Separated

Widowed

Single

Others, please specify: _______________________

Q7. Living arrangement of the elderly 1

Living with me most of the time (4 days or more a week on average)

Living with me when needed

Not living with me

Q8. Number of household members of the elderly Q9. Number of sons/daughters of the elderly Q10. Number of full time/part time domestic helpers of the elderly Q11. Average number of days per week to take care of the elderly: ______days Q12. Average number of hours per day to take care of the elderly: _____hours

4th elderly

No schooling/Pre-primary Education

3rd elderly

2nd elderly

Q5. Education level of elderly

1st elderly

(Please write down the answer in the appropriate box. If the respondent refuse to answer, please write “999”, if the answer is unknown, please write “777”.)

Part 2

Health condition of and use of health services by the elderly

Hypercholesterolemia

Diabetes

Joint disease (Such as arthritis, metabolic arthritis, osteoporosis)

Chronic respiratory disease (such as bronchitis, asthma)

Dementia

Stroke

Heart disease

Hearing impairment (such as tinnitus, deaf)

10 Eye disease (such as cataract, glaucoma) 11 Physically handicapped 12 Cancer (please specify:________________________) 13 Cutaneous condition 14 Depression 15 Other mental illness 16 Disease of the nervous system 17 Others, please specify:_________________________ 0

None of the above

Q14. Does the elderly need long-term prescription? 1

Yes

4th elderly

High blood pressure

3rd elderly

2nd elderly

Q13. Has the elderly ever been diagnosed with the following chronic diseases or disabilities? (You can choose more than one option)

1st elderly

(Please write down the answer in the appropriate box. If the respondent refuse to answer, please write “999”, if the answer is unknown, please write “777”.)

Q16. Did the elderly have medical consultation due to sickness last month (not including body check)? 1

Yes, number of time(s):_______

Q17. Has the elderly used the following medical services in the past 7 days? (You can choose more than one option.) 1

Geriatric Day Hospital

Accident & Emergency

Follow up consultation

Nursing services (such as drug injection and dressing)

Multi-disciplinary Risk Factor Assessment and Management Programme

Counselling on smoking cessation

Specialist Out-patient Clinics

General surgery treatment

Audiology

Nutrition

Occupational Therapy (Physical fitness)

Occupational Therapy (Psychiatric)

Physiotherapy

Podiatry

Prosthetic and Orthotic Therapy

Speech & Language Delay Therapy

Clinical Psychological Services

None of the above

4th elderly

Yes, number of time(s):_______

3rd elderly

2nd elderly

Q15. Has the elderly been admitted to the hospital in the past 12 months (not including body check)?

1st elderly

(Please write down the answer in the appropriate box. If the respondent refuse to answer, please write “999”, if the answer is unknown, please write “777”.)

Wearing clothes

Going to toilet

Going into and out of bed

Eating

Using the telephone

Shopping

Preparing food

Housework

Taking medicine

Handling finances

Laundry

Using transportation

None of the above

Other assistance, please specify: ____________

4th elderly

Bathing

3rd elderly

2nd elderly

Q18. Do you need to assist the elderly with the following activities? (You can choose more than one option.)

1st elderly

(Please write down the answer in the appropriate box. If the respondent refuse to answer, please write “999”, if the answer is unknown, please write “777”.)

Part 3

The needs of the elderly

Q19. To what extent do you think the elderly need the following community care services now? If he/she is in need, can the current service satisfy his/her needs? (The interviewer needs to use the display cards) I. To what extent does the elderly

need the community care services

II. If needed, whether

the current community care services can satisfy the needs (answer 2, 3, or 4 in Part I) N.A.(777)

Satisfied (1)

b Home help service

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

c Physiological,

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

d Financial

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

e Elder Academy

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

f Community social

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

g Community

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

h Participation in

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

elderly volunteering

Not satisfied (2)

(Do not give any hint) Do not know (9)

□（2） □（777）

recreational activities

Always (4)

□（1）

activities

Usually (3)

□（9）

management information

Occasionally (2)

□（0） □（1） □（2） □（3） □（4）

psychological, and social health information

No need now, may need in the future (1)

No need (0)

a Home care service

Outreach home visit service

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

Neighbourhood support/Respite service

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

k Community

meal/laundry service

I. To what extent does the elderly

II. If needed, whether

need the community care services

N.A.(777)

Not satisfied (2)

Satisfied (1)

(Do not give any hint)

Do not know (9)

Always (4)

Usually (3)

Occasionally (2)

Drug management (e.g. drug guidance, drug injection and dressing service)

No need now, may need in the future (1)

No need (0)

the current community care services can satisfy the needs (answer 2, 3, or 4 in Part I)

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

m Escort service

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

n Transportation

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

o Escort elderly in

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

p Counselling service

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

q Cognitive training

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

r Community

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

s Home rehabilitation

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

□（4）

□（9）

□（1）

□（2） □（777）

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

v Tele-consultation and □（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

services for escort use (e.g. Rehab bus, Access cars, Dial-a-ride service) community activities/shopping

service

rehabilitation service service

Health and home care □（0） □（1） □（2） □（3） assessment

u Discharge support service

health consultation

I. To what extent does the elderly

need the community care services

II. If needed, whether

the current community care services can satisfy the needs (answer 2, 3, or 4 in Part I) N.A.(777)

Satisfied (1)

Not satisfied (2)

(Do not give any hint) Do not know (9)

Always (4)

Usually (3)

□（9）

□（1）

□（2） □（777）

x Service

□（0） □（1） □（2） □（3） □（4）

□（9）

□（1）

□（2） □（777）

matching/Service referral for the elderly

Occasionally (2)

□（0） □（1） □（2） □（3） □（4）

tools(e.g. smart medicine box, personal emergency link service, health monitoring tools, smart rehabilitation tools)

No need now, may need in the future (1)

No need (0)

w Gerontech and

Q20. In the past month, did you arrange/use the following elderly community care services for the elderly? Have used in the past month, and have used before#

Have used in the past month, but never used before#

Did not use in the past month, but have used before#

Never used*

Hire local domestic helper

□（1）

□（2）

□（3）

□（4）

Hire foreign domestic helper

□（1）

□（2）

□（3）

□（4）

Hire home helper

□（1）

□（2）

□（3）

□（4）

District Elderly Community Centre/Neighbourhood Elderly Centre/Social Centres for the Elderly

□（1）

□（2）

□（3）

□（4）

Support Teams for the Elderly

□（1）

□（2）

□（3）

□（4）

Day Care Services for the Elderly

□（1）

□（2）

□（3）

□（4）

Have used in the past month, and have used before#

Have used in the past month, but never used before#

Did not use in the past month, but have used before#

Never used*

Day Respite Service for Elderly Persons

□（1）

□（2）

□（3）

□（4）

Enhanced Home and Community Care Services

□（1）

□（2）

□（3）

□（4）

Integrated Home Care Services

□（1）

□（2）

□（3）

□（4）

10 Pilot Scheme on Community Care Service Voucher for the Elderly

□（1）

□（2）

□（3）

□（4）

11 Integrated Discharge Support Program for Elderly Patients

□（1）

□（2）

□（3）

□（4）

12 Community Nursing Service

□（1）

□（2）

□（3）

□（4）

13 Others, please specify:_______

□（1）

□（2）

□（3）

□（4）

* If answered “never used before”, please answer Q21. # If answered “have used community care services”, please answer Q22.

Q21. If you have never used the abovementioned community care services before, what is the reason? (You can choose more than 1 option) 1 2 3 4 5 6 7 8 9

□ □ □ □ □ □ □ □ □

10 □

Not knowing service details No information about how to apply Inconvenient service location Long waiting time High cost Complicated application procedure Poor service quality Application rejected No community support services needed (e.g., able to take care of oneself, family members provide caregiving) Others, please specify: _________________________________________

Q22. If your district community centre could arrange mobile clinic in your community, what service(s) do you want to have? (You can choose more than

one option.) 1 2 3 4 5 6 7 8 9 10

□ □ □ □ □ □ □ □ □ □

Chinese medical consultation Western medical consultation Massage, treatment, and acupuncture Rehabilitation activities Health assessment Mental health assessment Medicine enquiries and management Disease prevention Referral service Other services:_______________________________________________

Q23. Have you ever applied for the escort vehicle for your elderly? 1

□

Yes  Skip to Q24

□

No  Skip to Q26

Q24. How much did you spend on using escort vehicles in the past month? HK$_______________ Q25. According to your past experience in using escort vehicles, how much was the cost of the escort vehicle per hour? 1 3 5 7 9 11

□ □ □ □ □ □

Below $60 $80 $100 $120 $140 More than $150 (please specify:_______)

2 4 6 8 10 0

□ □ □ □ □ □

$70 $90 $110 $130 $150 Forgotten

Q26. If your district community centre could provide the escort vehicle service in your community, will you apply for it for the elderly? 1

□

Yes  Skip to Q27

□

No  Skip to Q28

Q27. How much do you think is reasonable for using the escort vehicle service per hour?

1 3 5 7 9 11

□ □ □ □ □ □

Free $70 $90 $110 $130 $150

2 4 6 8 10 12

□ □ □ □ □ □

Below $60 $80 $100 $120 $140 More than $150 (please specify:________)

Q28. Does your elderly need other community support services? If yes, please state the community support services your elderly need. _________________________________________________________________________ _________________________________________________________________________ Q29. Do you agree with the following statement about elderly care?

1 The caregiver/elderly should

be able to choose the community support service with flexibility. 2 The need for elderly

community support services should be assessed by professionals. 3 Trained elderly volunteers

are able to provide community support services to the elderly. 4 It is good to have neighbours

providing community support services to the elderly. 5 The elderly who use

gerontech and tools will be helped to receive better community support services. 6 I am willing to purchase

gerontech and tools and services.

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

□（1）

□（2）

□（3）

□（4）

□（5）

□（1）

□（2）

□（3）

□（4）

□（5）

□（1）

□（2）

□（3）

□（4）

□（5）

□（1）

□（2）

□（3）

□（4）

□（5）

□（1）

□（2）

□（3）

□（4）

□（5）

□（1）

□（2）

□（3）

□（4）

□（5）

7 I am willing to spend more

money to get better quality community support services for the elderly. 8 There should be more respite

community support services for the elderly.

Part 4

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

□（1）

□（2）

□（3）

□（4）

□（5）

□（1）

□（2）

□（3）

□（4）

□（5）

The needs of the caregiver

Q30. As a caregiver, to what extent do you think you need the following community care services now? If you need them, do the current service satisfy your needs? I. To what extent does the

II. If needed, whether

caregiver need the community care services

the current community care services can satisfy the needs (answer 2, 3, or 4 in Part I) Not satisfied (2)

N.A.(777)

Satisfied( 1)

(Do not give any hint)

Do not know (9)

Always (4)

Physiological health information for the caregiver

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Psychological health information for the caregiver

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Social health information for the caregiver

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Health knowledge on the elderly

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Usually (3)

Occasionally (2)

No need now, may need in the future (1)

No need (0)

I. To what extent does the

II. If needed, whether

caregiver need the community care services

the current community care services can satisfy the needs (answer 2, 3, or 4 in Part I) Not satisfied (2)

N.A.(777)

Satisfied( 1)

(Do not give any hint)

Do not know (9)

Always (4)

Health information on the □（0） □（1） □（2） □（3） □（4） □（9） □（1） elderly (e.g., Health Care Voucher, community care services)

□（2）

□（777）

Caregiving courses and education

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Demonstration and leasing of rehabilitation equipment

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Drug management information (e.g. drug guidance, drug injection, and dressing service)

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Caregiver sharing and supportive activities

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Escorting the caregiver to the elderly’s home

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Elderly volunteering services

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Outreach home visit service

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Neighbourhood support/Respite service (e.g. child care)

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Residential respite service □（0） □（1） □（2） □（3） □（4） □（9） □（1） for the elderly

□（2）

□（777）

Counselling service

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Tele-consultation and health consultation

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Usually (3)

Occasionally (2)

No need now, may need in the future (1)

No need (0)

I. To what extent does the

II. If needed, whether

caregiver need the community care services

the current community care services can satisfy the needs (answer 2, 3, or 4 in Part I) Not satisfied (2)

N.A.(777)

Satisfied( 1)

(Do not give any hint)

Do not know (9)

Always (4)

Usually (3)

Occasionally (2)

No need now, may need in the future (1)

No need (0)

Service matching/Service referral for the elderly

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

□（2）

□（777）

Gerontech and tools (e.g., □（0） □（1） □（2） □（3） □（4） □（9） □（1） smart medicine box, personal emergency link service, health monitoring tools, smart rehabilitation tools)

□（2）

□（777）

Others, please specify:

□（2）

□（777）

□（0） □（1） □（2） □（3） □（4） □（9） □（1）

Q31. Do you feel stressful in taking care of the elderly? 1 3 0

□ □ □

2 4

Extremely A little Refuse to answer

□ □

Very much No

Q32. How is your health? 1 □ Excellent

2 □ Very good

3 □ Good

4 □ Fair

5 □ Poor

The following questions ask you about your level of satisfaction with your overall quality of life. Please choose the most appropriate answers based on your condition in the last 2 weeks.46

World Health Organization (2004). The World Health Organization quality of life (WHOQOL)-BREF. Retrieved from https://www.who.int/substance_abuse/research_tools/en/chinese_whoqol.pdf

Overall quality of life Q33. How would you rate your quality of life? 1 □ Very poor

2 □ Poor

3 □ Average

4 □Good

5 □Very good

Health condition Q34. How satisfied are you with your health? 1 □ Very dissatisfied 4 □ Satisfied

2 □ Dissatisfied 5 □ Very satisfied

3 □ Neither satisfied nor dissatisfied

Q35. For each of the following statements or questions, please circle the scale point that you feel is the most appropriate to describe you condition. (1)

a b c

(2)

(3)

(4)

In general, I consider myself:

1- Not a very happy person

Compared with most of my peers, I consider myself:

1- Less happy

Some people are generally very happy. They enjoy life regardless of what is going on, and getting the most out of everything. To what extent can these words describe you?

1- Not at all

□

(6)

(7)

7- A very happy person □

□

7- More happy □

□

7- Very well

□

Some people are not very 1- Not at all happy generally. □ □ Although they are not depressed, they never seem happy as they should be. To what extent can these words describe you?

Part 5

□

(5)

Basic information about the caregiver

□

7- Very well □

□

Q36. Age: _____________ years old (If the respondent refused to answer the actual age, please select the appropriate age group below.) 1

□

4 □ 7 □ 10 □

18–29 40–44 55–59 70–74

2 5 8 11

□ □ □ □

3 6 9

30–34 45–49 60–64 ≥75

□ □ □

35–39 50–54 65–69

Q37. Gender 1

□

Male

□

Female

Q38. Area of residence 1 3 5

□ □ □

2 □ Tai Po – Rural district 4 □ North Distract – Rural district Others, please specify:_______________

Tai Po – Urban district North District – Urban district

Q39. Marital status 1 3 5

□ □ □

2 4 6

Married Divorced Widowed

□ □ □

Cohabitation Separated Never married

Q40. Household information a. b. c.

Number of household members living together:________ Number of elderly who is 65 years old or above:_________ Number of household members working full/part time:_________

Q41. Education level 1 2 3 4

□ □ □ □

No schooling/Pre-primary education Primary school Secondary school Post-secondary education or above

Q42. Your occupation

1 2 3 4 5 6 7 8

□ □ □ □ □ □ □ □

Full-time employee Part-time/casual work employee Self-employed Employer Housekeeper Retired Unemployed/Waiting for employment Resigned from work due to caregiving

Personal income (in HK Dollars) Q43. What is your income from your part/full time job last month (including employee’s Mandatory Provident Fund contribution, income from temporary job, housing subsidy, bonus and double pay, etc.)?(Please give the bonus and double pay amount on a monthly basis.) 1□ 4□ 7□ 10 □ 0□

No income $10,000–$14,999 $25,000–$29,999 $40,000–$49,999 Refused to answer

2□ 5□ 8□ 11 □

Below $5,000 $15,000–$19,999 $30,000–$34,999 $50,000–$59,999

3□ 6□ 9□ 12 □

$5,000–$9,999 $20,000–$24,999 $35,000–$39,999 $60,000 or above

Q44. Do you have any financial difficulty? 1 □Yes

2 □No

Average monthly household income (in HK Dollars) Q45. What is the household income from part/full time jobs last month (including employee’s Mandatory Provident Fund contribution, income from temporary job, housing subsidy, bonus and double pay, etc.)? (Please give the bonus and double pay on a monthly basis.) 1□ 4□ 7□ 10 □ 0□

No income $10,000–$14,999 $25,000–$29,999 $40,000–$49,999 Refused to answer

2□ 5□ 8□ 11 □

Below $5,000 $15,000–$19,999 $30,000–$34,999 $50,000–$59,999

3□ 6□ 9□ 12 □

$5,000–$9,999 $20,000–$24,999 $35,000–$39,999 $60,000 or above

Q46. Do you receive the following government subsidies? (You can choose more than

one option.) 1

□

Comprehensive Social Security Assistance (CSSA) Scheme

□

Old Age Living Allowance

3 4 5 6

□ □ □ □

7 8 0

□ □ □

Low-income Working Family Allowance Scheme Normal Disability Allowance Old Age Allowance Community Care Fund – Living Allowance for Carers of Elderly Persons from Low-income Families Others, please specify:________________________________________ None of the above Refused to answer

Q47. Have you ever heard of the “Living Allowance for Carers of Elderly Persons from Low-income Families”? 1 □ Yes

2 □ No - End –

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