In Hong Kong, the Census and Statistics Department and the statistical units of various government bureaux and departments form the Government Statistical Service (GSS), are responsible for regulating and coordinating the network for the provision of statistical and geographic information. They also conduct statistical surveys and operating statistical systems for the production of social and economic statistics, including data series on population, external trade, commerce and industry, labour, prices, national income and balance of payments. In addition, they coordinate the Population Census every ten years since 1961 and the by-census is held between two censuses. The last census and by-census were held in June 2011 and June 2016 respectively, which are the most complete sources of sociodemographic information of the population. Besides, the Hong Kong Population Projections 2017-2066 not only presented population projections, but also made use of the most up-to-date information on fertility, mortality, and movement patterns of the population.

The total population size of Hong Kong at the end of 2018, is 7.49 million, of which 45.7% were male and 54.3% were female (Census and Statistics Department, 2019e). The majority of the population falls within the age range of 25-54 years (45.3%), followed by 65 years and over (17.3%), 55-64 years (16.2%), 0-14 years (11.5%) and 15-24 years (9.6%). In particular, the size of population aged 65 years and over is 1.30 million with 46.7% male and 53.3% female (Census and Statistics Department, 2019f).

The population of Hong Kong is ageing rapidly. The population median age increased from 40.0 years in 2007 to 43.9 years in 2017 (Census and Statistics Department, 2018c). Furthermore, it was estimated that it would continue to increase to 50.9 years in 2036 and further to 54.5 years in 2066 (Census and Statistics Department, 2017b).

Along with the trend of population ageing, Hong Kong is also facing an increasing dependency ratio. The total dependency ratio (number of persons aged under 15 and aged 65 and over per 1000 persons aged 15-64) was 386 in 2017 (Census and Statistics Department, 2018c), with a notable projected increase to 844 in 2066 (Census and Statistics Department, 2017b). The old-age dependency ratio (number of persons aged 65 and over per 1,000 persons aged 15-64) was 228 in 2017 (Census and Statistics Department, 2018c), with a notable projected increase to 674 in 2066 (Census and Statistics Department, 2017b).

References:

Census and Statistics Department. (2017b). Hong Kong Population Projections 2017–2066. In: Census and Statistics Department Hong Kong.

Census and Statistics Department. (2018c). Hong Kong Annual Digest of Statistics 2018 Edition. Hong Kong. Retrieved from https://www.statistics.gov.hk/pub/B10100032018AN18B0100.pdf

Census and Statistics Department. (2019e). Table 001: Population by Sex. Retrieved 9 October, 2019, from Census and Statistics Department, , HKSAR https://www.censtatd.gov.hk/showtablenewexcel.jsp?tableID=001&charsetID=1

Census and Statistics Department. (2019f). Table 002: Population by Age Group and Sex. Retrieved 9 October, 2019, from Census and Statistics Department, HKSAR https://www.censtatd.gov.hk/showtablenewexcel.jsp?tableID=002&charsetID=1

Hong Kong, a small urban city located at the south-eastern tip of China, has a total surface area of 1,106.66 km² that consists of the Hong Kong Island, the Kowloon Peninsula, the New Territories and 263 outlying islands (HKSAR Government, 2019a). It is one of the most densely populated places in the world with a population density of 6,890 people per km² in 2018 (Census and Statistics Department, 2019i). The proportion of urban population in Hong Kong is 100% of its total population since 1993 (World Bank, 2018). Hong Kong is geographically and administratively divided in 18 districts.

References:

Census and Statistics Department. (2019i). Table E489: Land area, mid-year population and population density by District Council district. Retrieved from: https://www.censtatd.gov.hk/hkstat/sub/sp150.jsp?productCode=D5320189

HKSAR Government. (2019a, February 2019). GovHK: Hong Kong – the Facts. Retrieved from https://www.gov.hk/en/about/abouthk/facts.htm

World Bank. (2018). Urban population (% of total population) Retrieved from: https://data.worldbank.org/indicator/SP.URB.TOTL.IN.ZS?locations=HK

The Basic Law of Hong Kong stipulates that Chinese and English are the two official languages of Hong Kong. In 2016, Cantonese is the predominant language spoken by 88.9% of the population and widely used in education, broadcasting, government administration, legislation, and judiciary, as well as for daily communication. English is a major working language spoken by 4.3% of the population and widely used in commercial activities and legal matters. Putonghua is more widely used due to the increase in tourism-related commerce from the mainland, which is spoken by 1.9% of the population. The proportion of population speaking other Chinese dialects is 3.1% and other language (Filipino, Indonesian, other Asian languages and other European languages) is 1.9% (HKSAR Government, 2019a).

Hong Kong is an ethnically homogenous society, with about 92% Chinese descent which comprise the vast majority of the population. For the non-Chinese population, it consists of various ethnic groups, including 31.5% Filipino, 26.2% Indonesian, 14.5% South Asian (6.2% Indian, 4.4% Nepalese, 3.1% Pakistani, 0.8% Bangladeshi and Sri-Lankan), 11.2% Mixed, 10.0% White,  1.7% Thai, 1.7% Japanese, 1.4% other Asian, 1.1% Korean, and 0.6% Black and Latin American (HKSAR Government, 2019a).

References:

HKSAR Government. (2019a, February 2019). GovHK: Hong Kong – the Facts. Retrieved from https://www.gov.hk/en/about/abouthk/facts.htm

The total population of Hong Kong was projected to increase from 7.34 million in mid-2016 to 8.14 million in mid-2036, and then decline to 7.72 million in mid-2066. Yet, for the population aged 65 and over, it was projected to expand from 1.16 million (16.6%) in 2016 to 2.37 million (31.3%) in 2036, and further increase to 2.59 million (33.7%) in 2066 (Census and Statistics Department, 2017b).

The population growth rate of Hong Kong was 1.0% in 2018 (Census and Statistics Department, 2019g). The total fertility rate (live births per 1,000 women) was projected to decrease from 1,205 in 2016 to 1,134 in 2036 and further to 1,166 in 2066 (Census and Statistics Department, 2017b).

References:

Census and Statistics Department. (2017b). Hong Kong Population Projections 2017–2066. In: Census and Statistics Department Hong Kong.

Census and Statistics Department. (2019g). Table 003: Population Growth by Component. Retrieved 9 October, 2019, from Census and Statistics Department, HKSAR https://www.censtatd.gov.hk/showtablenewexcel.jsp?tableID=003&charsetID=1

The size of the population aged 65 and over is increasing more and more rapidly. In 2018, there were 1301.6 thousand people (17.3% of total population) aged 65 and over, 568.6 thousand people (7.6% of total population) aged 75 and over, and 204.8 thousand people (2.7% of total population) aged 85 and over (Census and Statistics Department, 2019f). The proportion of population aged 65 and over was projected to increase sharply to 31.1% in 2036 and further to 36.6% in 2066 (Census and Statistics Department of HKSAR, 2017).

At the same time, the life expectancy of Hong Kong people is also increasing. The life expectancy at birth in Hong Kong in the year 2008 was 79.4 years for men and 85.5 years for women, while 2018 estimates showed an increment to 82.3 years for men and 87.7 years for women, respectively (Census and Statistics Department, 2019h).

References:

Census and Statistics Department of HKSAR. (2017). Hong Kong Population Projections 2017-2066. Hong Kong: Census and Statistics Department, Hong Kong Special Administrative Region Retrieved from https://www.statistics.gov.hk/pub/B1120015072017XXXXB0100.pdf

Census and Statistics Department. (2019f). Table 002: Population by Age Group and Sex. Retrieved 9 October, 2019, from Census and Statistics Department, HKSAR https://www.censtatd.gov.hk/showtablenewexcel.jsp?tableID=002&charsetID=1

Census and Statistics Department. (2019h). Table E484: Hong Kong Life Tables. Retrieved 9 October, 2019, from Census and Statistics Department, HKSAR.

Hong Kong is a small and highly dense city in which people can relocate across district (within the city) without any application for migration. Relocation of residence within Hong Kong is common especially among rental households. The Census and Statistics Department regularly captures the change of residence of the population age 5 and over. In 2016 population by-census, 10.6% (745,369 persons) had internally migrated from one district to another compared to five years ago (i.e., 2011-2016). Among them, 12.2% (90,936 persons) were aged 65 or over, consisting of 44.3% males (40,264 persons) and 55.7% females (50,672 persons) (Census and Statistics Department, 2018b).

For international migration, there are no official statistics exactly recording the number of migrants moving into or out of Hong Kong. Instead, based on the number of residents, the Census and Statistics Department constantly records the net movement of Hong Kong residents (i.e., inflow less outflow). It is important to note that, this figure will cover the inflow and outflow of permanent residents as well as non-permanent residents. Non-permanent residents moving in or out of Hong Kong are usually not migrants but one-way permit holder from mainland China, foreign domestic helpers, or individuals holding working or student visa. From the year end of 2017 to 2018, there was a net movement of 66,700 persons into Hong Kong (Census and Statistics Department, 2019g), of which 42,300 were one-way permit holders from the mainland China (Census and Statistics Department, 2019j).

References:

Census and Statistics Department. (2018b). Hong Kong 2016 Population By-census – Thematic Report: Older Persons. Hong Kong Retrieved from https://www.bycensus2016.gov.hk/data/16BC_Older_persons_report.pdf

Census and Statistics Department. (2019g). Table 003: Population Growth by Component. Retrieved 9 October, 2019, from Census and Statistics Department, HKSAR https://www.censtatd.gov.hk/showtablenewexcel.jsp?tableID=003&charsetID=1

Census and Statistics Department. (2019j). Women and Men in Hong Kong – Key Statistics 2019 Edition. Hong Kong Retrieved from https://www.statistics.gov.hk/pub/B11303032019AN19B0100.pdf

The Centre for Health Protection of Hong Kong estimated that 39.6% of persons aged 15 or above reported one or more doctor-diagnosed chronic conditions in year 2014/2015. There were 9 types of significant non-communicable diseases covered in the population health survey conducted by this centre, including hypertension, high blood cholesterol, diabetes mellitus, coronary heart disease, asthma, cancer, stroke, chronic obstructive pulmonary disease, and dementia. Among them, the top 3 most self-reported conditions in 2017 were hypertension (male 17.6%, female 17.9%), high blood cholesterol (male 14.8%, female 14.0%), and diabetes mellitus (male 5.4%, female 5.6%) (Centre for Health Protection, 2017). The next round of population health survey in Hong Kong will be conducted in year 2020.

The Department of Health reported the ten leading causes of death by gender in 2017 (HealthyHK, 2018, July 19). The top 3 leading causes for both genders were: 1. malignant neoplasms, 2. pneumonia, and 3. disease of heart. Dementia was the 8^th and 5^th leading cause of death for males and females respectively.

References:

Centre for Health Protection. (2017). Report of Population Health Survey 2014/15. Retrieved from https://www.chp.gov.hk/en/static/51256.html

Healthy HK. (2018, July 19). Leading cause of all deaths.

HIV and AIDS

In 2018, there were 624 HIV reports and 139 AIDS report in Hong Kong. A cumulative total of 9,715 reports of HIV infection and 1,996 AIDS cases was identified under the voluntary and anonymous HIV/AIDS reporting system of the Department of Health launched since 1985. In 2018, 1 in every 9,850 new blood donors, 1 in every 264 attendees in Sexually Transmitted Diseases (STD) Clinics, and 1 in every 110 users in methadone clinics were tested HIV positive. Most of the HIV reports were male (85%) and Chinese (72%). Most infected people (78%) were diagnosed at the age between 20 and 49. People infected with HIV progress to AIDS when they suffer from clinical complications of severe immunodeficiency due to HIV. The most common illnesses presenting at AIDS were pneumocystis pneumonia and tuberculosis.

Tuberculosis

Tuberculosis (TB) is an important infectious disease in Hong Kong. In 2018, there was a total of 4,326 TB notifications with male to female ratio of 1.7:1 (Centre for Health Protection, 2019, February 4a). It was rare in children under 15 years old but more common among old people. The total number of deaths caused by TB was 179 (132 male and 47 female) (Centre for Health Protection, 2019, February 4b) respectively.

Seasonal influenza

Seasonal influenza is a common respiratory tract infection caused by human seasonal influenza viruses. In Hong Kong, it is more common in periods from January to April and from July to August (Centre for Health Protection, 2020a). Centre for Health Protection has been closely monitoring the weekly numbers of institutional influenza-like illness outbreaks and influenza-associated admission rate in public hospitals (Centre for Health Protection, 2020a). In 2019, there were 24,215 positive detections of seasonal influenza viruses under laboratory surveillance (Centre for Health Protection, 2020c).  In 2018/2019 winter, it caused 5,217 cases of adult ICU admission and 2,942 cases of adult death with laboratory confirmation (Centre for Health Protection, 2020b).

References:

Centre for Health Protection. (2019, February 4a). Notification & death rate of tuberculosis (all forms), 1947-2018. Retrieved from https://www.chp.gov.hk/en/statistics/data/10/26/43/88.html

Centre for Health Protection. (2019, February 4b). Tuberculosis notifications (all forms) and rate by age group and sex, 2018 (Provisional). Retrieved from https://www.chp.gov.hk/en/statistics/data/10/26/43/6825.html

Centre for Health Protection. (2020a). Explanatory notes on the intensity levels for seasonal influenza in Hong Kong. Retrieved from https://www.chp.gov.hk/files/pdf/explanatory_note_for_flux_mem_eng.pdf

Centre for Health Protection. (2020b). Flu Express. Retrieved from: https://www.chp.gov.hk/files/xls/flux_data.xlsx

Centre for Health Protection. (2020c). Flu Express-Weekly surveillance data Retrieved from: https://www.chp.gov.hk/files/xls/flux_data.xlsx

Virtual AIDS Office of Hong Kong. (2019, May). HIV/AIDS Situation in Hong Kong [2018]. Hong Kong Retrieved from https://www.aids.gov.hk/english/surveillance/sur_report/hiv_fc2018e.pdf.

According to the Injury Survey 2008 conducted by the Centre for Health Protection, 6.2% of the Hong Kong population (415,200 persons) reported at least one unintentional injury that limited their normal activities in the past 12 months. The prevalence rate was similar for both genders and was found to be highest for those aged 75 and over (8.9%). The most common causes of injury episodes were falls (32.2%), sprain (25.8%) and sports (14.1%). Falls were found to be most common cause of injury episodes in females (40.8%) and among those aged 75 and over (74.3%) (Centre for Health Protection, 2010). The average cost of the total medical expenses incurred in each injury episode was HK$1,929 (median HK$300). The total cost incurred as a result of injuries was estimated at HK$838.6 million (95% CI HK$473.9 million to HK$1,203.4 million) in 2008. The cost was increasing with age and the highest in persons aged 65 and over (median for those aged 65 and over: HK$500). More than half of the injury episodes (51.3%) sustained by employed persons caused them to be absent from work temporarily for an average of 19.8 days (median 7.0 days). The mean and median of paid sick leaves taken were 13.5 and 5.0 days respectively. About 36.2% of the injury episodes caused the victims to change their normal daily activities and 1.4% caused them to develop residual disabilities for 6 months or longer. 13.0% of the injury episodes were reported to cause a decline in usual household income (Centre for Health Protection, 2010; 2015). The next round of such survey, namely Unintentional Injury Survey 2018, was conducted by the Centre for Health Protection and completed in 2019. Survey results are yet to be released.

In 2013, there were 1,860 registered deaths related to injuries, which made injuries the 5^th leading cause of death in Hong Kong. Among the deaths related to injuries, the top 3 leading causes were intentional self-harm (53.7%), falls (12.5%) and transport accidents (7.5%). For the potential years of life lost at age 75, injuries ranked second among all causes of death (after cancer) and accounted for 15.7% of the total potential year lost  (Centre for Health Protection, 2015).

References:

Centre for Health Protection. (2010). Injury Survey 2008. Hong Kong Retrieved from https://www.chp.gov.hk/files/pdf/injury_survey_eng.pdf

Centre for Health Protection. (2015). Action Plan to Strengthen Prevention of Unintentional Injuries in Hong Kong. Hong Kong: Department of Health, HKSAR. Retrieved from https://www.change4health.gov.hk/filemanager/common/image/strategic_framework/injuries_action_plan/injuries_action_plan_e.pdf

The economy of Hong Kong is a highly developed free-market economy characterised by low taxation, almost free port trade and well-established international financial market. In 2018, the GDP of Hong Kong is recorded at HK$2,845.3 billion with an annual growth rate of +5.9%. The GDP per capita is recorded at HK$381,870 with an annual growth rate of +5.1% (Census and Statistics Department, 2019c). Hong Kong has been classified as high-income by the World Bank (World Bank, 2019).

References:

Census and Statistics Department. (2019c). Hong Kong in Figures 2019 Edition. Hong Kong. Retrieved from https://www.statistics.gov.hk/pub/B10100062019AN19B0100.pdf

World Bank. (2019). Hong Kong SAR, China Retrieved from: https://data.worldbank.org/country/hong-kong-sar-china?view=chart

The four key industries in Hong Kong were 1) financial services (% of GDP in 2017: 18.9%), 2) tourism (4.5%), 3) trading and logistics (21.5%), and 4) professional and other producer services (12.2%). In 2017, these four industries generated a total of value added of $1,456.6 billion (57.1% of GDP) and employed 1,780,200 persons (46.6% of total employment) (Census and Statistics Department, 2019b).

References:

Census and Statistics Department. (2019b). The Four Key Industries and Other Selected Industries. Hong Kong: Census and Statistics Department, HKSAR. Retrieved from https://www.statistics.gov.hk/pub/B71905FA2019XXXXB0100.pdf

For public debt, in the first quarter of 2019, the Gross External Debt (ED) on Hong Kong (measuring total outstanding gross external liabilities other than equity liabilities) was $12,695.3 billion, which was equivalent to 4.4 times of GDP. The components of ED were attributable to the banking sector (62.0%), other sectors (22.4%) (consisting of 73.2% long-term and 26.8% short-term liabilities), and debt liabilities in direct investment (intercompany lending) (15.4%). ED of the Government amounted to $26.7 billion, of which nearly all was long-term liabilities. This was attributable to non-residents’ holdings of debt securities issued by the Government. ED of the Hong Kong Monetary Authority amounted to $3.4 billion, of which 81.3% ($2.8 billion) was long-term liabilities of Exchange Fund Notes (Census and Statistics Department, 2019a).

For private debt, residential mortgage lending constitutes the major proportion of household loans in Hong Kong, while the remainder comprises personal loans such as unsecured lending through credit card and other private purposes. The growth in household loans accelerated from 3.9% in the second half of 2018 to 6.7% in the first half of 2019. It was driven by a stable growth in residential mortgage loans and a strong growth in loans for other private purposes in private banking and wealth management customers, which were secured by various financial assets (i.e., stocks, mutual funds, and insurance policies). With household debt growing faster than the nominal GDP, the household debt-to-GDP ratio rose to 75.5% in the second quarter of 2019 (Hong Kong Monetary Authority, 2019).

References:

Census and Statistics Department. (2019a). Balance of Payments, International Investment Position and External Debt Statistics of Hong Kong (First Quarter 2019). Hong Kong: Census and Statistics Department, HKSAR. Retrieved from https://www.statistics.gov.hk/pub/B10400012019QQ01B0100.pdf

Hong Kong Monetary Authority. (2019). Half-Yearly Monetary & Financial Stability Report (September 2019). Hong Kong Retrieved from https://www.hkma.gov.hk/media/eng/publication-and-research/quarterly-bulletin/qb201909/E_Half-yearly_201909.pdf.

Since 2013, the Hong Kong Government has officially defined the poverty line as 50% of the median monthly domestic household income. The poverty lines of from 1-person to 6-person+ household in 2017 were HK$4,000, HK$9,800, HK$15,000, HK$19,900, HK$20,300, and HK$22,500 respectively (HKSAR Government, 2018). Households with monthly household income lower than the poverty line are defined as “poor households” and all members of these households are referred as “poor population”.

The poverty situation of Hong Kong can be reflected by four sets of indicators, including one set of “before-intervention” statistics and three sets of “after-intervention” statistics. The “before-intervention” poverty statistics are compiled with the assumption of no prevailing government policies and measures, which form an objective benchmark for assessing the effectiveness of intervention. It only includes household members’ employment earnings, investment income, and non-social-transfer cash income. “After-intervention” poverty statistics are compiled by further including the income provided by the government policies and measures, such as taxation, recurrent-cash benefits, non-recurrent cash benefits, and in-kind benefits. In 2017, the poverty rate before intervention was 20.1% (1,376,600 persons). After recurrent cash intervention, the poverty rate improved to 14.7% (1,008,800 persons). Among those aged 65 and over, the poverty rate after recurrent cash intervention was 30.5% (340,000 persons) (HKSAR Government, 2018).

Inequality between a society’s rich and poor is often measured by the Gini coefficient, with zero indicating equality. In 2016, the Gini coefficient of Hong Kong based on original monthly household income was 0.539 and that based on post-tax post-social transfer monthly household income was 0.473. It was the highest over the past 45 years with an increase of 0.006 points since 2006, and worse than other developed economies such as Singapore (0.356), United States (0.391), United Kingdom (0.351), Australia (0.337), and Canada (0.318) (Census and Statistics Department, 2017a; Oxfam Hong Kong, 2018).

For gender inequality in income, the median monthly income of males and females in 2016 were $16,890 and $12,000 respectively, with males’ income 40.8% higher. Also, there was a higher percentage of working women (9.1%) (excluding foreign domestic helpers) with monthly income from main employment below $6,000 than that of men (4.6%). The difference between income of working women and men can be attributed to differences between working women and men in industrial and occupational distributions, educational attainment, working experience, and nature of work. For example, proportionally more women (19.8%) than men (8.7%) worked as clerical support workers who had relatively lower monthly income from main employment in 2016. On the other hand, there was a higher proportion of men (21.2%) working as managers and administrators and professionals than women (13.1%) who had relatively higher monthly income (Census and Statistics Department, 2017a).

References:

Census and Statistics Department. (2017a). Hong Kong 2016 Population By-census – Thematic Report: Household Income Distribution in Hong Kong. Retrieved from https://www.censtatd.gov.hk/hkstat/sub/sp459.jsp?productCode=B1120096

HKSAR Government. (2018). Hong Kong Poverty Situation Report 2017. Hong Kong: HKSAR Government Retrieved from https://www.povertyrelief.gov.hk/eng/pdf/Hong_Kong_Poverty_Situation_Report_2017(2018.11.19).pdf.

Oxfam Hong Kong. (2018). Hong Kong Inequality Report. Retrieved from https://www.oxfam.org.hk/tc/f/news_and_publication/16372/Oxfam_inequality%20report_Eng_FINAL.pdf

Hong Kong’s climate is seasonal due to alternating wind direction between winter and summer. From September to December there are pleasant breezes, plenty of sunshine, and comfortable temperatures. January and February are cloudier, with occasional cold fronts followed by dry northerly winds. March and April are milder although there are occasional spells of high humidity. The period from April to August is hot and humid with occasional showers and thunderstorms. The months from July to September are most likely to be affected by severe weather phenomena such as tropical cyclones, monsoon troughs, and thunderstorms. There are on average about 30 tropical cyclones form in the western North Pacific or China Seas every year, and about half of them reach typhoon strength. Heavy rain from tropical cyclones may last for a few days and subsequent landslips and flooding sometimes cause considerably more damage than the winds (Hong Kong Observatory, 2018, November 30). Waterspouts and hailstorms occur infrequently, snow and tornadoes are rare, and there is a very small chance of major earthquakes (Hong Kong Observatory, 2018, November 27). Moreover, Hong Kong is not seriously affected by tsunami (Hong Kong Observatory, 2018, November 8).

References:

Hong Kong Observatory. (2018, November 8). Tsunami Monitoring and Warning in Hong Kong. Retrieved from http://www.weather.gov.hk/gts/equake/tsunami_mon_e.htm

Hong Kong Observatory. (2018, November 27). Chance of a Significant Earthquake in Hong Kong. Retrieved from http://www.weather.gov.hk/gts/equake/sig_eq_chance_e.htm

Hong Kong Observatory. (2018, November 30). Climate of Hong Kong. Retrieved from http://www.weather.gov.hk/cis/climahk_e.htm

In 2018, the labour force statistics estimated that the unemployment rate was 2.8% (112.0 thousand people) and the underemployment rate was 1.1% (43.2 thousand people). The unemployment rates by gender for male and female were 3.2% and 2.9%, respectively (Census and Statistics Department, 2019i).

References:

Census and Statistics Department. (2019i). Table E489: Land area, mid-year population and population density by District Council district. Retrieved from: https://www.censtatd.gov.hk/hkstat/sub/sp150.jsp?productCode=D5320189

Economy activities are highly regulated and mostly taxed in Hong Kong. Most of employers are regulated by the Companies Ordinance and the Society Ordinance, whereas all forms of employment, including full-time, part-time, permanent, and temporary, are protected by the Employment Ordinance and Employee’s Compensation Ordinance. For self-employed individuals without a contractual agreement, their rights and benefits are less protected, and their income is taxable. As a result, the size of informal economy in Hong Kong is very small. The followings are the two major types of informal workers in Hong Kong: 1) foreign domestic helpers and 2) hawkers.

Foreign domestic helper is the main type of informal care workers in Hong Kong. By the end of 2018, there were a total of 386,075 foreign domestic helpers in Hong Kong (Census and Statistics Department, 2019j) and they comprised 5.2% of HK population as well as 9.7% of labour force (Census and Statistics Department, 2019j). Their income is not taxable. It is important to note that, unlike other countries, the rights and benefits of foreign domestic helpers in Hong Kong are protected, as well as the local citizens by the Employment Ordinance and monitored by the Immigration Department.

Hawkers refer to vendors selling street food and inexpensive goods in Hong Kong. Due to concerns about the city’s hygiene and health, the Government has begun to decrease the number of hawker licenses and impose stricter restrictions on hawking activities since 1970s. The number of licensed hawkers had dropped from over 70,000 in 1940s to 50,000 in 1970s. By the end of 2018, there were only 5,531 licensed hawkers, including fixed-pitch or itinerant (i.e., travelling) hawkers. At the same time, the Food and Environmental Hygiene Department has exerted strict control over illegal hawking activities and there were only around 1,511 hawkers by the end of 2018 (Food and Environmental Hygiene Department, 2019, September 5).

References:

Census and Statistics Department. (2019j). Women and Men in Hong Kong – Key Statistics 2019 Edition. Hong Kong Retrieved from https://www.statistics.gov.hk/pub/B11303032019AN19B0100.pdf

Food and Environmental Hygiene Department. (2019, September 5). Hawker Control. Retrieved from https://www.fehd.gov.hk/english/pleasant_environment/hawker/control.html

In Hong Kong, preschool education is not free and is operated by non-profit-making and private enterprises. Primary, junior secondary, and senior secondary education for a total of 12 years are universal, mandatory, and free. For post-secondary education, higher education institutions provide publicly-funded as well as self-financing programmes at or above sub-degree level (Education Bureau, 2019). Regarding the population’s education level in 2018, the total population of no schooling/pre-primary was 3.8% (243.9 thousand people), primary was 14.1% (920.3 thousand people), lower secondary was 15.0% (973.0 thousand people), upper secondary was 34.0% (2214.1 thousand people), post-secondary non-degree was 7.7% (503.2 thousand people), and post-secondary degree was 25.4% (1651.9 thousand people). Among those aged 60 and over, the distribution of educational attainment were: 12.6% no schooling/pre-primary, 37.2% primary, 18.3 % lower secondary, 21.1% upper secondary, 3.3% post-secondary non-degree, and 7.5% post-secondary degree (Census and Statistics Department, 2019i).

References:

Census and Statistics Department. (2019i). Table E489: Land area, mid-year population and population density by District Council district. Retrieved from: https://www.censtatd.gov.hk/hkstat/sub/sp150.jsp?productCode=D5320189

Education Bureau. (2019). Education System and Policy. Retrieved from https://www.edb.gov.hk/en/index.html

In Hong Kong, the overall objective of social security is aiming to provide for the basic and special needs of the members of the community who are in need of financial or material assistance. There are five social protection schemes implemented by the government. The Comprehensive Social Security Assistance Scheme and Social Security Allowance Scheme are the two major ones, while the others are Criminal and Law Enforcement Injuries Compensation Scheme, Traffic Accident Victims Assistance Scheme, and Emergency Relief.

The Comprehensive Social Security Assistance (CSSA) Scheme is to provide a safety net for individuals who cannot support themselves financially. It is means-tested and designed to bring their income up to a prescribed level to meet their basic needs. To be eligible for CSSA, a person must satisfy the residence requirement, pass financial tests of household income and asset, and additional criteria for able-bodied adults. The payments are classified into three types, namely, standard rates, supplements, and special grants (Social Welfare Department, 2019, July 30). In 2019, the amounts of standard rates for an able-bodied and 100% disabled single elderly person aged 65 or above were HK$3,585 and HK$4,335 per month respectively, And the amount of Long-term supplement (a major type of supplement under the scheme; for persons with ill-health owing to old age, disability or medical conditions) was HK$2,445 per year (Social Welfare Department, 2019d).

The Social Security Allowance (SSA) Scheme is to provide a monthly allowance to Hong Kong residents to meet special needs arising from disability or old age (Social Welfare Department, 2019, September 6). It includes the 1) Old Age Allowance (HK$1,385 per month) that is  universal for older adults aged 70 or over, 2) Old Age Living Allowance (HK$2,675 / HK$3,585) that is means-tested and designed for those aged 65 or over with financial difficulties, and 3) Disability Allowance (HK$1,770 / HK$3,540) that is provided for those with severe disability (Social Welfare Department, 2019d).

In Hong Kong, various local NGOs and charities are offering conditional social protection schemes for vulnerable groups and those with emergent needs in the form of one-off cash transfer and food aid. All these schemes targeted individuals or families that are not benefited from the social protection schemes provided by the Government. For example, the “Rainbow Fund” emergency allowance provided by The Community Chest (The Community Chest, n.d.), the “Apple Daily Fund” emergency allowance provided by Apple Daily Charitable Foundation (Apple Daily Charitable Foundation, 2020), the “SAGE Fund for the Elderly” provided by The Hong Kong Society for the Aged (The Hong Kong Society for the Aged, n.d.), the “Emergency Fund for Divided Families” provided by International Social Service Hong Kong Branch (International Social Service Hong Kong Branch, n.d.), the “Food for All” food assistance service provided by Tung Wah Group of Hospitals (Tung Wah Group of Hospitals, n.d.), and the “Hotmeal” food assistance services provided by Baptist Oi Kwan Social Service (Baptist Oi Kwan Social Service, n.d.).

In 2019, the number of households receiving Comprehensive Social Security Assistance, the major form of social security in Hong Kong, was 222,331 (8.5% of the total 2,628,800 domestic households) (Social Welfare Department, 2019, July 30).

References:

Apple Daily Charitable Foundation. (2020). Apple Daily Fund. Retrieved from https://hk-charity.nextmedia.com/site/index.php?fuseaction=site.aboutUs

Baptist Oi Kwan Social Service. (n.d.). Hotmeal. Retrieved from https://bokss.org.hk/poverty-alleviation-project/service?id=99&_lang=en

International Social Service Hong Kong Branch. (n.d.). Cross-Boundary and Inter-Country Social Service. Retrieved from http://www.isshk.org/en-us/services/index/CBIC

Social Welfare Department. (2019, July 30). Comprehensive Social Security Assistance (CSSA) Scheme. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_socsecu/sub_comprehens/

Social Welfare Department. (2019, July 30). Comprehensive Social Security Assistance (CSSA) Scheme. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_socsecu/sub_comprehens/

Social Welfare Department. (2019, September 6). Social Security Allowance (SSA) Scheme. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_socsecu/sub_ssallowance/

Social Welfare Department. (2019d). Social Security. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_socsecu/sub_socialsecurity/

The Community Chest. (n.d.). Rainbow Fund-Introduction. Retrieved from https://www.commchest.org/en/rainbow-fund

The Hong Kong Society for the Aged. (n.d.). SAGE Fund for the Elderly. Retrieved from https://www.sage.org.hk/Service/Fund.aspx?lang=en-US

Tung Wah Group of Hospitals. (n.d.). “Food for All” Service Background.

Under the principle of ‘One Country, Two Systems’, Hong Kong became a Special Administrative Region (SAR) of the People’s Republic of China on 1 July 1997. This arrangement allows the city to enjoy a high degree of autonomy, including retaining its capitalist system, independent judiciary and rule of law, free trade, and freedom of speech. According to the Basic Law, Hong Kong’s political system and autonomy would remain unchanged for 50 years until 2047. It designates a three-branch system of governance led by the Chief Executive and the Executive Council, with a two-tiered system of representative government (i.e., Legislative Council and District Council), and the independent judiciary (HKSAR Government, 2019, May-b). The structure of the government is described below:

• The Chief Executive and Executive Council

The Chief Executive (CE) is the head of the government, which is elected by a broadly representative Election Committee in accordance with the Basic Law and is appointed by the Central People’s Government. It is responsible for implementing the Basic Law, signing bills and budgets, promulgating laws, making decisions on government policies, and issuing Executive Orders. The term length of CE is five years and possible consecutive renewal for once only. He or she is assisted in policy making by the Executive Council (HKSAR Government, 2019, May-b).

The Executive Council assists the CE in policymaking and advises the CE on matters relating to the introduction of bills and subsidiary legislation. It consists of 16 official and 16 non-official members. All members are appointed by the CE from among the senior officials of the executive authorities, members of the Legislative Council and public figures. It serves for a period no longer than the expiry of the CE’s term of office (HKSAR Government, 2019, May-b).

• Legislative Council and District Councils

The Legislative Council is the law-making body of Hong Kong currently comprising 70 members. It also debates issues of public interest, examines and approves budgets, receives and debates the Chief Executive’s policy addresses, and endorses the appointment and removal of the judges of the Court of Final Appeal and the Chief Judge of the High Court (HKSAR Government, 2019, May-b). The terms of the Legislative Council are four years.

The District Councils, currently consisting of 479 seats, undertakes improvement projects and promote recreational, cultural, and community activities in their respective districts. They also advise the Government on matters that affect the well-being of residents and the adequacy and priorities of government programmes (HKSAR Government, 2019, May-b). The terms of the District Council are also four years.

• The Judiciary

The Basic Law ensures that Hong Kong remains within the common law system. It is independent from the legislative and executive branches of government, with the courts showing no bias. For the most serious types of criminal offences, a jury decides whether the accused is guilty or not, with a majority vote required. The Court of Final Appeal is the highest appellate court and is headed by the Chief Justice (HKSAR Government, 2019, May-b).

References:

HKSAR Government. (2019, May-b). Government Structure. Retrieved from https://www.gov.hk/en/about/govdirectory/govstructure.htm

Hong Kong was once a fishing village with floating communities. It was colonised by the United Kingdom in 1842 and handed over People’s Republic of China in 1997. Hong Kong is best known as a glamorous city with skyscrapers and a combination of Eastern and Western culture. It is a world-class centre of business, travel, and a financial hub for international trade (Hong Kong Tourism Board, 2019).

References:

Hong Kong Tourism Board. (2019). About Hong Kong: History. Retrieved from http://www.discoverhongkong.com/eng/plan-your-trip/traveller-info/about-hong-kong/history.jsp

Although Hong Kong has a high degree of autonomy, universal suffrage is currently only granted in District Council elections, and in elections for half of the Legislative Council. The Chief Executive of Hong Kong is elected through an electoral college with the majority of its members elected by a limited number of voters mainly within business and professional sectors.

Chief Executive election

The Chief Executive electione are held every 5 years, with the last one (5th term) held on 26 March 2017. It is elected by a broadly representative Election Committee (EC), which is composed of 1,200 members under 38 subsectors, comprising (a) 1,034 members of 35 subsectors who are returned through elections; (b) 106 ex-officio members (i.e., Hong Kong deputies of the National People’s Congress (NPC) and Members of the Legislative Council (LegCo) under the NPC subsector and the LegCo subsector); and (c) 60 members under the Religious subsector who are nominated by six designated bodies. The term of office is 5 years and will commence on the 1^st of February of the same year. The next election will be held in the year of 2022  (Constitutional and Mainland Affairs Bureau, 2019, April 30).

Legislative Council election

The Legislative Council election is held every 4 years, with the last one held on 4 September 2016 and followed by two by-elections respectively held on the 11^th of March and on the 25^th of November 2018. It is composed of 70 members, of which 35 are elected directly by geographical constituencies and 35 are elected by functional constituencies (including five elected by the District Council (second) functional constituency). The next election will be held in the year of 2020 (HKSAR Government, 2019, May-b).

District Council election

The District Council election is held every 4 years, with the last one held on the 24^th of November 2019. It is composed of 458 members under 18 District Councils, of which 431 are elected members and 27 are ex-officio members (i.e., Rural Committee Chairmen in the New Territories) (District Council Election 2015, 2015 September 22). The next election will be held in 2023 (Constitutional and Mainland Affairs Bureau 2019, July 8).

References:

Constitutional and Mainland Affairs Bureau (2019, July 8). HKSAR District Council Election. Retrieved from https://www.cmab.gov.hk/en/issues/electoral3.htm

Constitutional and Mainland Affairs Bureau. (2019, April 30). Chief Executive Election. Retrieved from https://www.cmab.gov.hk/en/issues/electoral1.htm

District Council Election 2015. (2015, September 22). District Council Brief. Retrieved from https://www.elections.gov.hk/dc2015/eng/dcbriefs.html#2

HKSAR Government. (2019, May-b). Government Structure. Retrieved from https://www.gov.hk/en/about/govdirectory/govstructure.htm

The Corruption Perceptions Index measures perceived levels of public sector corruption according to experts and business people. Hong Kong ranks 14^th (out of 180 participating countries) on the Corruption Perceptions Index 2018, with a score of 76/100 (Transparency International, 2019).

References:

Transparency International. (2019). Global Corruption Perception Index 2018. Retrieved from https://www.transparency.org/cpi2018

Political Stability indicator measures perceptions of the likelihood that the government will be destabilised or overthrown by unconstitutional or violent means, including politically motivated violence and terrorism. The measure ranges from approximately -2.5 (weak) to 2.5 (strong) governance performance. The World Bank provides data for Hong Kong from 1996 to 2017. The average value for Hong Kong during that period was 0.98 points with a minimum of 0.58 points in 1996 and a maximum of 1.34 points in 2005. In 2017, the Political Stability indicator was 0.85, which was in the middle rank (World Bank, 2017).

References:

World Bank. (2017). Worldwide Governance Indicators Retrieved from: https://databank.worldbank.org/source/worldwide-governance-indicators

The public health services are financed by the Government and regulated by the Food and Health Bureau (FHB), Department of Health (DH), and Hospital Authority (HA) (HKSAR Government, 2019b).

• Food and Health Bureau (FHB)

It is one of the policy bureaus of the Government responsible for forming policies and allocating resources for health services. It ensures that these policies are carried out effectively to protect and promote public health, and provide lifelong holistic health care to every resident (HKSAR Government, 2019b).

• Department of Health (DH)

Under the FHB, the Department of Health serves as health adviser and agency to execute healthcare policies and statutory functions. It safeguards the community’s health through a range of promotional, preventive, curative, and rehabilitative services. It also provides subsidised healthcare services through health centres and clinics in each district (HKSAR Government, 2019b).

• The Hospital Authority (HA)

The Hospital Authority is a statutory body established under the Hospital Authority Ordinance in 1990. It is accountable to the Government through the Secretary of FHB and provides public hospital services for the whole Hong Kong territory. Every Hong Kong resident is eligible for subsidised healthcare services through 43 public hospitals, 73 general out-patient clinics and 49 specialist out-patient clinics operated by HA (HKSAR Government, 2019b; Hospital Authority, 2019a).

The public sector provides most of the secondary and tertiary care services in Hong Kong. Public hospitals under HA manage approximately 80% of all hospital admissions and the share of total bed-days reaches almost 90%. As of 31 March 2019, a total of 28,929 hospital beds were provided in public hospitals. Nearly all critical emergencies are tackled by the accident and emergency departments of public hospitals (Food and Health Bureau, 2017b).

Regarding the proportion of population using public healthcare, the Census and Statistics Department conducted a household survey on the population’s use of doctor consultation, hospitalisation, and dental consultation in 2016/17. While only 29.2% of doctor consultations took place in the public sector, 70.9% of the hospital admissions in Hong Kong were handled by public hospitals under Hospital Authority. Further breakdown of these findings by age and gender can be found from the survey report (Census and Statistics Department, 2017, December).

References:

Census and Statistics Department. (2017, December). Thematic Household Survey Report No. 63. Retrieved from https://www.statistics.gov.hk/pub/B11302632017XXXXB0100.pdf

Food and Health Bureau. (2017b). Report of the Strategic Review on Healthcare Manpower Planning and Professional Development.

HKSAR Government. (2019b, March). Overview of the Health Care System in Hong Kong. Retrieved from https://www.gov.hk/en/residents/health/hosp/overview.htm

Hospital Authority. (2019a). Clusters, Hospitals & Institutions. Retrieved from http://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=10084&Lang=ENG&Dimension=100&Parent_ID=10042

Hospital Authority. (2019b). Hospital Authority Statistical Report 2018-2019.  Retrieved from https://www3.ha.org.hk/data/HAStatistics/DownloadReport/12?isPreview=False.

There are 12 private hospitals and 2,146 registered private clinics in Hong Kong (Electronic Health Record Registration Office, 2019) providing hospital service, primary care, and a broad range of specialist services. As of 31^st of March 2019, a total of 4,657 hospital beds were provided in private hospitals (Department of Health, 2019b). The Department of Health regulates all private hospitals and clinics under the Medical Clinics Ordinance (Cap.343) on their compliance with relevant regulations by conducting inspections and handling medical incidents and complaints lodged by the public. All Western and Chinese medicine practitioners have to register with the Medical Council of Hong Kong and the Chinese Medicine Council of Hong Kong, respectively (Hospital Authority, 2019a).

Private sector dominates the provision of primary care in Hong Kong, accounting for about 70% of all medical and dental visits (Food and Health Bureau, 2017b). The proportion of the population making use of doctor consultations, hospitalisation, and dental consultations in the private sector in 2016/17 is summarised in Table 2.2 above. Most of the doctor consultations (67.6%), which consisted of 49.5% and 18.1% of Western and Chinese medicine practitioner use respectively, occurred in the private sector. In contrast, only 30.7% of hospitalisation were handled by the private sector (Census and Statistics Department, 2017, December).

References:

Census and Statistics Department. (2017, December). Thematic Household Survey Report No. 63. Retrieved from https://www.statistics.gov.hk/pub/B11302632017XXXXB0100.pdf

Department of Health. (2019b). Health Facts of Hong Kong 2019 Edition.  Retrieved from https://www.dh.gov.hk/english/statistics/statistics_hs/files/Health_Statistics_pamphlet_E.pdf.

Electronic Health Record Registration Office. (2019). Electronic Health Record Sharing Sysem: List of Registered Healthcare Provider – Private Clinics.  Retrieved 11 October, 2019, from Electronic Health Record Registration Office, HKSAR

Food and Health Bureau. (2017b). Report of the Strategic Review on Healthcare Manpower Planning and Professional Development.

Hospital Authority. (2019a). Clusters, Hospitals & Institutions. Retrieved from http://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=10084&Lang=ENG&Dimension=100&Parent_ID=100421q

Every resident in Hong Kong can access primary care services directly by walking-in or making a telephone appointment. Private practitioners are distributed over nearly every community for convenient access. The Government has established the Primary Care Directory which is a web-based electronic database containing contact details, practice information, and professional qualifications of primary care providers in Hong Kong. This facilitates the public to search for suitable family doctors, dentists, and Chinese medicine practitioners in the community (Food and Health Bureau, 2019c). For public healthcare, since the general outpatient clinics are usually overloaded by older adults and persons with chronic illness who need regular follow-up, citizens who cannot afford private doctor consultations or insist in using public primary care have to walk in and queue up for a daily quota early in the morning or they can make a telephone booking for an appointment in the next 24 hours. The Telephone Appointment System of public general outpatient clinics operates 24 hours a day. In 2016, the Government introduced the Electronic Health Record Sharing System (eHRSS), a territory-wide, patient-oriented electronic sharing platform, for both authorised public and private health practitioners to access and share participating patients’ health records to enable more timely diagnosis and treatment, and reduce duplicate diagnostic tests (HKSAR Government, 2019, October). For emergency services, the public ambulance service 999 is free for anyone in Hong Kong. For access to secondary and tertiary care, either public or private, referral from a general practitioner is necessary.

References:

Food and Health Bureau. (2019c, October 1). Primary Care Directory. Retrieved from https://www.pcdirectory.gov.hk/english/welcome/welcome.html

HKSAR Government. (2019, October). Electronic Health Record Sharing System. Retrieved from https://www.gov.hk/en/residents/health/hosp/eHRSS.htm

Primary care is the first point of contact for continuing the healthcare pathway in Hong Kong. Primary care practitioners act as gatekeepers making recommendations and referrals to specialists according to the patients’ health care needs (Kung et al., 2007; Ng, 2006). While there is a long waiting time for public specialist outpatient services, patients can opt for private specialists in hospital and clinics at their own expense for a shorter waiting time.

References:

Kung, K., Lam, A., & Li, P. (2007). Referrals from general practitioners to medical specialist outpatient clinics: effect of feedback and letter templates. Hong Kong Practitioner, 29(9).

Ng, W. (2006). Primary Healthcare. Healthcare Policy Forum/Hong Kong Democratic Foundation.

Hong Kong’s health system provides universal access to a wide range of public healthcare services, including inpatient care, general and specialist outpatient care, health protection and promotion, prevention services, and community services. Yet, like in many developed countries, affordability is a significant barrier to effective use of healthcare services in Hong Kong. In particular, inequity is most apparent in access to outpatient services. Long waiting time is a huge and common issue for public specialist outpatient services and accident and emergency services (Leung & Bacon-Shone, 2006; Our Hong Kong Foundation, 2018). Such long waiting times disproportionately impact patients with a lower income who have difficulty affording private care or are left living with diminished access to public health services (Yam et al., 2011).

References:

Leung, G. M., & Bacon-Shone, J. (2006). Hong Kong’s health system: Reflections, perspectives and visions: Hong Kong University Press. https://doi.org/10.1136/jech.2007.061143

Our Hong Kong Foundation. (2018). Fit for Purpose: A Health System for the 21st Century. Retrieved from https://www.ourhkfoundation.org.hk/sites/default/files/media/pdf/ohkf_research_report_digital_1201.pdf

Yam, C. H., Liu, S., Huang, O. H., Yeoh, E., & Griffiths, S. M. J. B. h. s. r. (2011). Can vouchers make a difference to the use of private primary care services by older people? Experience from the healthcare reform programme in Hong Kong. 11(1), 255. https://doi.org/10.1186/1472-6963-11-255

The public health system is fully financed by the Government from taxation, following the policy that no one in Hong Kong should be denied medical care due to lack of means. Nearly 93% of the costs involved in delivering public health services are financed by public funding. The public system, thus, serves as a safety net for residents by making public health services available to all residents at an affordable price. People who have financial difficulties are exempted from payment of medical fees and charges for health services. Under the medical fee waiving mechanism, recipients of the Comprehensive Social Security Assistance and other vulnerable groups are waived from payment of public health care expenses when they meet certain financial and social criteria (Food and Health Bureau, 2017b).

The private health system is financed through patients’ out of pocket payments and it offers healthcare services to those who can afford them and are willing to pay for more flexible services at their own expense (Food and Health Bureau, 2017b). The Government also provides different funds for patients in need to pay for their medical fees and charges, for example, the Samaritan Fund, the Community Care Fund Medical Assistance Programmes, and the Health Care Voucher. The Samaritan Fund provides financial assistance to needy patients for designated privately purchased medical items or new technologies of medical treatment which are not covered by the standard fees and charges in public hospitals and clinics (Hospital Authority, 2020c). The Community Care Fund Medical Assistance Programmes assist patients in purchasing specified self-financed cancer drugs, ultra-expensive drugs, and specified implantable medical devices for interventional procedures (Hospital Authority, 2020a). The Health Care Voucher provides an annual amount of $2,000 to older people aged 65 and above which allow them to choose private health services including preventive care (Health Care Voucher, 2019).

References:

Food and Health Bureau. (2017b). Report of the Strategic Review on Healthcare Manpower Planning and Professional Development.

Health Care Voucher. (2019, June 26). Background of Elderly Health Care Voucher Scheme.

Hospital Authority. (2020a). Community Care Fund Medical Assistance Programmes. Retrieved from https://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=206049&Lang=ENG&Dimension=100&Parent_ID=10044&Ver=HTML

Hospital Authority. (2020c). Samaritan Fund. Retrieved from https://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=10048&Lang=ENG&Dimension=100&Parent_ID=10044

Health insurance is not mandatory in Hong Kong. Residents can choose to buy private health insurance based on their own needs. In 2016, 3.26 million people (47% of total population) were protected by private health insurance, comprising 1.48 million people with individual-based health insurance policies, 0.86 million people with group-based policies and 0.92 million people with both types of policies (The Legislative Council Secretariat, 2018). These health insurance claims are usually used for payments of specialist services and hospitalisation in the private sector since the patients can access healthcare services without waiting.

In April 2019, the Government officially launched the Voluntary Health Insurance Scheme (VHIS) that aims at encouraging the public to purchase health insurance in order to reduce the pressure on the public health system in the long run (Food and Health Bureau, 2019d). Hospital insurance products offered by various insurance companies which meet prescribed minimum standards, are certified under the VHIS. As an incentive for purchasing VHIS, an annual tax deduction up to HK$8,000 is provided per premium paid for certified insurance plans by each insured person and his/her dependants (The Legislative Council Secretariat, 2018). As of September 2019, the number of insurance policies purchased under VHIS exceeded 300 000.

References:

Food and Health Bureau. (2019d). Voluntary Health Insurance Scheme. About VHIS. Retrieved from https://www.vhis.gov.hk/en/about_us/scheme.html

Legislative Council Secretariat. (2018). Research Brief Issue No. 2 2017 – 2018 – The 2018-2019 Budget. Hong Kong: Legislative Council, HKSAR Retrieved from https://www.legco.gov.hk/research-publications/english/1718rb02-the-2018-2019-budget-20180412-e.pdf.

In 2017/2018, 49% of the current health expenditure was covered by the Government, 34% by household out-of-pocket payments, and 16% by payment via privately purchased insurance schemes and employer-based insurance schemes. High out-of-pocket expenses indicate a potentially catastrophic impact of ill health on family incomes in Hong Kong (Food and Health Bureau, 2019b).

References:

AD MediLink. (2019). How Much Do Private Hospitals Charge in Hong Kong?

Food and Health Bureau. (2019b). ESTIMATES OF HEALTH EXPENDITURE.

Hospital Authority. (2020b). Fees and Charges.

No.

The Government is responsible for deciding on the allocation of funding for healthcare services in Hong Kong. It involves the Chief Executive, Legislative Council, Financial Secretary, and Secretary of Food and Health Bureau, which work together to ensure the equitable distribution, allocation, and utilisation of financial resources for health care services.

In Hong Kong, the control and management of the public finances are governed by the Public Finance Ordinance. The preparation of the estimates of the Government’s revenue and expenditure for the upcoming financial year is under the responsibility of the Financial Secretary while the approval of the Budget rests with the Legislative Council (Legislative Council Secretariat, 2019b). The budgetary process follows the following cycle: 1) In every August / September, the Chief Executive conducts the first round of Budget consultations on expenditure for the next year’s Budget as part of the Policy Address consultations; 2) In September / October, the Financial Secretary gives out operating expenditure envelopes to bureaux and departments; 3) In October, it is the beginning of the new legislative session. The Chief Executive delivers the Policy Address; 4) from October to February, the Financial Secretary conducts the second round of Budget consultations on revenue for next year’s Budget; 5) In February, the Financial Secretary introduces the Appropriation Bill and the Estimates of Expenditure into the Legislative Council. First and Second Reading of the Appropriation Bill; 6) from February to March, the President of the Legislative Council refers the Estimates of Expenditure to the Finance Committee for examination. The Finance Committee examines the Estimates of Expenditure. The Appropriation Bill is debated and passed by the Legislative Council. Resumption of Second Reading debate and Third Reading of the Appropriation Bill. After passage of the Appropriation Bill, the Finance Committee examines the Government’s proposals to change the approved Estimates of Expenditure; 7) end of March is the end of financial year; and 8) in June/ July, the Financial Secretary or the Secretary for Financial Services and the Treasury introduces the Supplementary Appropriation Bill to seek approval of a supplementary appropriation for the services of the Government.

References:

Legislative Council Secretariat. (2019b). Legistrative Council in Brief No. 8 – How does the Legistrative Council approve public expenditure. Hong Kong: Legislative Council, HKSAR Retrieved from https://www.legco.gov.hk/education/files/english/Factsheet/Factsheet8.pdf.

The Government sets the budget priorities annually. The Chief Executive and Financial Secretary conducts Budget consultations, Appropriation Bill, Estimates of Expenditure, and Reading debates through the Legislative Council to make decisions on how the funding should be spent.

For each financial year, the Financial Secretary decides on the allocation of health budgets for the Hospital Authority and the Department of Health, the two main bodies in charge of public healthcare services. After receiving the budget allocated, they decide about their own internal budget allocation. According to the 2019-2020 Budget, the estimated recurrent government expenditure on public healthcare services was increased by 10.9% reaching the amount of $80.6 billion in 2019-2020 and accounting for 18.3% of the total recurrent government expenditure (The 2019-20 Budget, 2019a). The Government increased the recurrent financial provision for Hospital Authority by 8% to $68.8 billion and Department of Health by 27.9% to $13,301 million. The Government also committed to sustain the development of public healthcare with the establishment of $10 billion public healthcare stabilisation fund (Hospital Authority, 2019c; The 2019-20 Budget, 2019b).

For Hospital Authority, the health budget is further dispersed through the 7 clusters responsible for different geographical areas (including Hong Kong East, Hong Kong West, Kowloon Central, Kowloon East, Kowloon West, New Territories East, and New Territories West) by considering the population growth, demographic changes, incidence of chronic illness, healthcare service utilisation pattern, and organisation of services of each cluster and hospital (The Government of the Hong Kong SAR, 2017). Within each cluster, the budgets are further dispersed through programme areas in response to the service needs of each cluster.

References:

Hospital Authority. (2019c). Hospital Authority welcomes budget allocation for 2019-20.

The 2019-20 Budget. (2019a). Budget Speech.

The 2019-20 Budget. (2019b). Estimates – DEPARTMENT OF HEALTH.

The Government of the Hong Kong SAR. (2017). LCQ13: Resource allocation of Hospital Authority [Press release]. Retrieved from https://www.info.gov.hk/gia/general/201712/13/P2017121300666.htm

For the Department of Health, the budget is dispersed across its 8 programme areas. Among them, the top 3 areas in 2019 were disease prevention (57.5%, HK$7,654.3 million), medical and dental treatment for civil servants (15.9%, HK$2,111.1 million), and statuary functions (10.9%, HK$ 1,451.9 million) (The 2019-20 Budget, 2019b).

References:

The 2019-20 Budget. (2019b). Estimates – DEPARTMENT OF HEALTH.

1.48 million people purchased private individual-based health insurance (IHI) in 2016. The penetration ratio of IHI products in local population has surged from 20% in 2006 to 34% in 2016. Although almost all of the insurance policies covered inpatient care, less than three-fifths of the insured people received such care in private hospitals due to hesitation on premium transparency and budget certainty in existing products (The Legislative Council Secretariat, 2018, July).

References:

The Legislative Council Secretariat. (2018, July). Health insurance for individuals in Hong Kong.  Retrieved from https://www.legco.gov.hk/research-publications/english/1718rb03-health-insurance-for-individuals-in-hong-kong-20180703-e.pdf.

The Insurance Authority is an insurance regulator independent of the Government. It modernises the regulatory infrastructure to facilitate the stable development of the Hong Kong insurance industry, it provides better protection for policy holders, and it complies with the requirement of the International Association of Insurance Supervisors (Insurance Authority, n.d.).

References:

Insurance Authority. (n.d.). History. Retrieved from https://www.ia.org.hk/en/aboutus/role/history.html

In 2017/2018, 49% of the current health expenditure was covered by the Government, 34% by household out-of-pocket payments, and 16% by payment via privately purchased insurance schemes and employer-based insurance schemes. High out-of-pocket expenses indicate a potentially catastrophic impact of ill health on family incomes in Hong Kong (Food and Health Bureau, 2019b).

References:

Food and Health Bureau. (2019b). ESTIMATES OF HEALTH EXPENDITURE.

No, remittances are not related to financing health care in Hong Kong.

No, there are no significant amounts of donations from outside Hong Kong to support the healthcare system.

In 2019, Hong Kong has 196 doctors, 2 geriatricians, 2 neurologists, 99 Chinese medicine practitioners, 568 registered nurses, and 190 enrolled nurses per 100,000 population (Department of Health, 2019b; The Medical Council of Hong Kong, 2017).

References:

Department of Health. (2019b). Health Facts of Hong Kong 2019 Edition.  Retrieved from https://www.dh.gov.hk/english/statistics/statistics_hs/files/Health_Statistics_pamphlet_E.pdf.

The Medical Council of Hong Kong. (2017). Annual Report 2017. Retrieved from Hong Kong: https://www.mchk.org.hk/files/annual/files/2017/MCAR_2017_e.pdf

In Hong Kong, there is general shortage of healthcare manpower in the health system (Food and Health Bureau, 2017b). According to the Association of Hong Kong Nursing Staff, the nurse-to-patient ratio of night-shifts in public hospitals in 2013 was 1:24. This means that each nurse needed to take care of 24 patients on average, and such ratio was far worse than the international standard at 1:6 (HKSAR Government, 2018, April 25). In 2016-2017, there was a shortage of 300 doctors and 600 nurses. By projection to 2030, there will be a shortage of over 1,000 doctors and 1,600 nurses (HKSAR Government, 2017, July 12). The actual workforce requirements of health services are projected from 138,000 in 2017 to 183,800 in 2027. The projected average annual rate of change is +2.9% (Census and Statistics Department, 2019d).

The Hospital Authority has been implementing various measures to retain staff and alleviate the tight workforce situation of frontline nursing staff, including continuous recruitment of nurses, ward clerks and assistants, establishment of the Special Retired and Rehire Scheme, enhancement of promotion and training opportunities, improvement of work environment, enhancement of preceptorship support, and reinstating the annual increment mechanism (HKSAR Government, 2018, April 25). To address workforce shortages in the short-term, the Hospital Authority has employed non-locally trained doctors with limited registration to practise in Hong Kong (HKSAR Government, 2017, July 12). Besides, the Government has substantially increased the number of funded healthcare training places by about 60% (about 1,800 students) over the past 10 years. It also encouraged self-financing institutions to provide more subsidised training places (about 860 students) for healthcare professionals in the 2018/19 academic year (HKSAR Government, 2018, April 25).

References:

Census and Statistics Department. (2019d). Report on Manpower Projection to 2027. Retrieved from https://www.statistics.gov.hk/pub/B1050016E2019XXXXE0100.pdf

Food and Health Bureau. (2017b). Report of the Strategic Review on Healthcare Manpower Planning and Professional Development.

HKSAR Government. (2017, July 12). LCQ17: Manpower of healthcare professionals [Press release]. Retrieved from https://www.info.gov.hk/gia/general/201707/12/P2017071200517.htm?fontSize=1

HKSAR Government. (2018, April 25). LCQ19: Healthcare manpower [Press release]. Retrieved from https://www.info.gov.hk/gia/general/201804/25/P2018042500725.htm?fontSize=1

Locally trained health care workers usually stay in Hong Kong for practice. Migration does not play a significant role in the availability of health care workers in Hong Kong. In particular for doctors, up to the end of 2018, overseas-trained doctors constituted 24.9% of the total doctor supply in Hong Kong. This proportion is expected to continue to shrink due to retirement or other reasons as the criteria for overseas-trained doctors to practice in Hong Kong had become very stringent since September 1996. Among the doctors in practice, the number of overseas-trained doctors who became qualified after 1996 (i.e., 506) is only one-sixth of that before 1996 (i.e., 3152) (Legislative Council Secretariat, 2019a). If the existing policy for overseas-trained doctor remains unchanged, locally trained doctors will continue to be the main source of medical practitioners in Hong Kong.

References:

Legislative Council Secretariat. (2019a). Admission of overseas-trained doctors in Singapore and Australia.  Retrieved from https://www.legco.gov.hk/research-publications/english/1819in13-admission-of-overseas-trained-doctors-in-singapore-and-australia-20190509-e.pdf.

Hong Kong has a universal public long-term care system mainly implemented by the Social Welfare Department and various NGOs. Long-term care services cover both community and residential care for older adults with proven needs under a standardised care need assessment mechanism. Facing the ageing population, the Government aims to promote “ageing-in-place” that encourages older adults to age at home rather than being institutionalised by strengthening its provision of community care services in the recent years. However, the LTC system is being criticised for its long waiting time for subsidised services, the unbalance of resources for residential over community care, and the heavy reliance on the Government’s finance. Partly owing to the insufficient capacity of the community care, many older adults have chosen to enter residential care homes for their late life, resulting in high institutionalisation rate compared with other developed countries.

Hong Kong has a public long-term care (LTC) system, which is a universal system built on the principle of social equity. LTC services in Hong Kong are regulated by the Social Welfare Department and provided by various NGOs under public subvention to elderly citizens (aged 65 and over) with proven care needs which are assessed under the Standardised Care Need Assessment Mechanism for Elderly Services (SCNAMES). The Mechanism covers applications for subsidised community care and residential care services. Assessors under this Mechanism are professionals from various disciplines, such as social workers, nurses, occupational therapists, and physiotherapists, who are required to be trained and to be accredited for the use of the assessment tool. Older people are eligible for subsidised LTC services if they are assessed as moderately or severely impaired (e.g., defined by age, physical and cognitive functional disability, and dependency) under SCNAMES. If subsidised care places are not readily available, eligible older people will be placed on the Central Waiting List on a first-come-first-served basis according to their registration dates and preferences. The major potential barrier to access LTC services in Hong Kong is its insufficient supply, which results in long waiting times for different types of service (Social Welfare Department, 2019a). Since public LTC service in Hong Kong is universal as well as almost fully subsidised and distributed over the territory, factors such as gender, race, income, and geographical location do not contribute as barriers to access LTC services.

References:

Social Welfare Department. (2019a). List of Self-financing Day Care Centres for the Elderly (as at March 2019). Hong Kong: Social Welfare Department, HKSAR Retrieved from https://www.swd.gov.hk/storage/asset/section/616/en/List_of_self-financing_DE_(March_2019).pdf.

Public elderly services in Hong Kong are broadly divided into Community Care Services and Residential Care Services. Community Care and Support Services are provided by 41 District Elderly Community Centres (DECC), 169 Neighbourhood Elderly Centres (NEC), 60 teams of Integrated Home Care Services (IHCS), 34 teams of Enhanced Home and Community Care Services (EHCCS) and 77 units of Day Care Centre/Unit for the Elderly (DE/DCU). Only IHCS for frail cases, EHCCS and DE/DCU are categorised under LTC services. Residential Care Services consist of two types of residential care homes, namely, Care-and-Attention (C&A) Home and Nursing Home (NH). As of  31^st of December 2019, there are 28,160 subsidised residential places (37% of total residential places) (Social Welfare Department, 2019c).

Both the needs for community and residential care services generally increase with age. In 2015, 70.3% of Community Care Services users and 79.4% of Residential Care Services users are aged 80 and over (Working Group on Elderly Services Programme Plan, 2017).

In 2016, it was estimated that the demand for subsidised LTC services was 59,572 places, yet, there was only 37,957 places available. It was also projected that the demand for subsidised LTC services will increase to 77,989 places in 2030 and reaching a peak of 124,609 places in 2051. With the rapid increase in the ageing population, together with the decrease in capacity of family carers in the coming decades, there will be a severe upward pressure on the demand for LTC services, especially for Residential Care Services (Working Group on Elderly Services Programme Plan, 2017). On the 31^st December 2019, a total of 10,573 applicants had been on the waiting list for subsidised community care services with the average waiting time of 14-15 months (Social Welfare Department, 2020f), and 41,011 applicants for residential care services with the average waiting time of 20-22 months (Social Welfare Department, 2020j).

The Social Welfare Department also launched the Pilot Residential Care Services Scheme in Guangdong, a nearby province in the mainland China, which gives elderly persons the opportunity to chose to live in the subsidised residential care homes for the elderly (RCHEs) in Shenzhen and Zhaoqing, both operated by two Hong Kong-based NGOs (Social Welfare Department, 2019, September 30).

References:

Social Welfare Department. (2019, September 30). Pilot Residential Care Services Scheme in Guangdong. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_residentia/id_guangdong/

Social Welfare Department. (2019c). Provision of Residential Care Services for the Elderly (Subsidised versus Non subsidised Places) as at 31.12.2019. Hong Kong: Social Welfare Department, HKSAR Retrieved from https://www.swd.gov.hk/storage/asset/section/632/en/Dec%202019/3.Provision_of_RCHEs_(Subsidised_versus_Non-subsidised_Places)(31.12.19).pdf.

Social Welfare Department. (2020f). LTC Statistics CCS-Eng (Dec_2019).  Retrieved from https://www.swd.gov.hk/storage/asset/section/2789/en/LTC_Statistics_CCS(Eng)(Dec_2019).pdf.

Social Welfare Department. (2020j). Statistics on waiting list for subsidised residential care services for the elderly (Dec 2019).  Retrieved from https://www.swd.gov.hk/storage/asset/section/632/en/LTC_statistics_HP-Eng(201912).pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The private sector provides both Community and Residential Care Services in Hong Kong. For Community Care Services, NGOs operate on a self-financing or full cost-recovery basis. As of 31^st of March 2019, there were 81 self-financing Day Care Centres for the Elderly (Social Welfare Department, 2019a). Private organisations provide mostly home-based private nursing services. For Residential Care Services, NGOs and private organisations provide a total of 47,644 (63% of total residential places) non-subsidised residential places in private nursing homes as of 31^st of December 2019 (Social Welfare Department, 2019c). Currently, there is no information on the proportion and characteristics of the users of private LTC services.

References:

Social Welfare Department. (2019a). List of Self-financing Day Care Centres for the Elderly (as at March 2019). Hong Kong: Social Welfare Department, HKSAR Retrieved from https://www.swd.gov.hk/storage/asset/section/616/en/List_of_self-financing_DE_(March_2019).pdf.

Social Welfare Department. (2019c). Provision of Residential Care Services for the Elderly (Subsidised versus Non subsidised Places) as at 31.12.2019. Hong Kong: Social Welfare Department, HKSAR Retrieved from https://www.swd.gov.hk/storage/asset/section/632/en/Dec%202019/3.Provision_of_RCHEs_(Subsidised_versus_Non-subsidised_Places)(31.12.19).pdf

The Government is the main funding body of public LTC services with taxes, land premium, and investment income as major sources of revenues. There is no LTC insurance in Hong Kong. On average about 80-90% of the unit service cost of subsidised LTC services is borne by the Government. For Community Care Services, service users only pay for 4% of the cost of home-based services and 10% of centre-based services. For Residential Care Services, service users generally pay 10-20% of the cost. In most cases, for non-subsidised services provided by self-financing NGOs and private organisations, consumer pays the full cost. Around 80% service users of non-subsidised Residential Care Service receive an indirect full subsidy form the Government through the Comprehensive Social Security Assistance Scheme (Working Group on Elderly Services Programme Plan, 2017).

References:

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The Hong Kong government is responsible for deciding the funding for LTC services. It involves the Chief Executive, Legislative Council, Financial Secretary, and Secretary for Labour and Welfare, which work together to ensure the equitable distribution, allocation, and utilisation of public financial resources for LTC services.

In Hong Kong, the control and management of the public finances are governed by the Public Finance Ordinance (Cap. 2). The preparation of the estimates of the Government’s revenue and expenditure for the upcoming financial year is the responsibility of the Financial Secretary while the approval of the Budget rests with the Legislative Council (Legislative Council Secretariat, 2019b). For an illustration of the budgetary process, please 02.02.04.03 in Part 2.

References:

Legislative Council Secretariat. (2019b). Legistrative Council in Brief No. 8 – How does the Legistrative Council approve public expenditure. Hong Kong: Legislative Council, HKSAR Retrieved from https://www.legco.gov.hk/education/files/english/Factsheet/Factsheet8.pdf.

The Hong Kong government sets the budget priorities annually. The Chief Executive and Financial Secretary conducts Budget consultations, Appropriation Bill, Estimates of Expenditure, and Reading debates through the Legislative Council to make decisions on how the funding will be spent. The Elderly Commission was established in 1997 to serve as a platform facilitating coordination among bureaux, departments, and organisations to provide advice to the Government (Working Group on Elderly Services Programme Plan, 2017).

References:

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

LTC budgets are allocated to the Social Welfare Department and then dispersed across various service providers of subsidised services in different districts which deliver different types of services.

Subsidised community care services are provided predominantly by non-governmental organisations (NGOs) receiving funding mostly from the Government, supplemented by donations and users fees. Residential care services are delivered by a mix of NGOs and private providers. The Government provides financial subsidies to NGOs through subvention with service quality monitored by the Social Welfare Department (Yuen, 2014). Despite the long standing government policy of “ageing in place”, there is a significant imbalance in government expenditures on residential care ($4,793.9 millions) and community care ($2,364.6 millions) according to the report in the 2017-2018 financial year (Legislative Council Secretariat, 2019, December 13).

References:

Legislative Council Secretariat. (2019, December 13). Government expenditure on the elderly. Retrieved from https://www.legco.gov.hk/research-publications/english/1920rt02-government-expenditure-on-the-elderly-20191213-e.pdf.

Yuen, P. P. (2014). Financing Health Care and Long-term Care in a Rapidly Ageing Context: Assessing Hong Kong’s Readiness. Public Policy and Administration, 17(1), 56-64.

The Lump Sum Grant is the key means of subvention for LTC services. It was introduced in 2000-2001 for voluntary adoption by NGOs. The Social Welfare Department no longer imposes rigid input controls on NGOs’ staffing and salary structures or on individual items of expenditure. Recurrent funding is granted to NGOs in a lump sum and NGOs are given greater autonomy and flexibility to deploy resources and re-engineer their services to meet changing social needs. As of August 2018, 164 out of 169 funded NGOs have joined the Lump Sum Grant system and the subvention for these NGOs represents over 99% of the total recurrent subvention for 2017-18 (Social Welfare Department, 2019b). Some NGOs receive heavy subsidies from the Government, covering almost full operating expenses, capital costs, and the provision of premises. Some NGOs and private providers operate on a self-financing basis. Government also has a programme to subsidise residents to stay in privately run facilities, known as the “Enhanced Bought Place Scheme” (Yuen, 2014).

In addition, the Government has from time to time applied for funds from the Lotteries Fund to finance the development of elderly services. These include funds for the construction and setting-up of contract residential care homes for the elderly (RCHEs) and for the implementation of various welfare projects/schemes for the elderly (e.g., Pilot Scheme on Community Care Service Voucher for the Elderly). NGOs may also apply for grants to meet the capital costs of projects in connection with elderly services provided (Audit Commission, 2014, October).

References:

Audit Commission. (2014, October). Provision of long-term care services for the elderly.  Retrieved from https://www.aud.gov.hk/pdf_e/e63ch01.pdf

Social Welfare Department. (2019b, 28 January 2019). Lump Sum Grant (LSG) Subvention System. Retrieved from https://www.swd.gov.hk/en/index/site_ngo/page_subventions/sub_modesofsub/id_lsgmanualc/

Yuen, P. P. (2014). Financing Health Care and Long-term Care in a Rapidly Ageing Context: Assessing Hong Kong’s Readiness. Public Policy and Administration, 17(1), 56-64.

Health insurance is not mandatory and LTC insurance is not available in Hong Kong. As a result, most of the LTC service in Hong Kong is financed by the government. Other than the government’s direct budget for LTC, it is partly covered by other mechanisms, but still indirectly from the government. For public LTC service, the Government finances it by direct budget allocation. For private LTC service, if the user is a Comprehensive Social Security Assistance Scheme (i.e., major social protection scheme in Hong Kong) recipient, the service cost will also be covered by the Government through social security payment (i.e., indirect subsidy). Around 80% of those using non-subsidised Residential Care Service are on Comprehensive Social Security Assistance Scheme (Working Group on Elderly Services Programme Plan, 2017).

References:

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

There is no private LTC insurance product available in Hong Kong.

For Community Care Service, the charges for private day care services range from $2,300 to $7,200 per month (compared with $900 to $1,000 per month for subsidised services). The charges for professional care services range from $160 to $200 per 45 minutes for Nurse / Occupational Therapist / Physiotherapist services, and from $50 to $100 per hour for Personal Care Worker / Health Worker services. The charges for miscellaneous domiciliary care services (i.e., home cleaning, home attending, home care, meal delivery, escort service) range from $25 to $100, while some operators would provide concessionary charge for Comprehensive Social Security Assistance recipients (Sau Po Centre on Ageing, 2011).

To relieve burden brought by the out-of-pocket payment, the Government has launched the Pilot Scheme on Community Care Service Voucher for the Elderly (CCSV) with a maximum number of 7,000 vouchers. Elderly persons are required to pay for the co-payment amount according to the rate of the service package value (i.e., monthly voucher values are $9,600, $8,150, $7,260, $5,810, and $4,020) while the government will pay for the remaining amount of the service package value. Under the “affordable users pay” principle, the less the elderly person can afford, the more the Government subsidises (Social Welfare Department, 2020, January 23; 2020, February 3).

For Residential Care Service, the monthly charge for non-subsidised places in self-financing homes, contract homes and private homes vary widely from $4,500 to $21,000 (compared with $1,656 to $2,060 per month for subsidised services) (Social Welfare Department, 2019, November 7). There are also additional miscellaneous charges to cover items, such as out-patient escort services ($100 to $500 per time), diapers ($5 to $10 per use / $500 to $2,400 per month), toilet papers ($2 to $5 per roll), TV electricity ($50 to $200 per month), air conditioning ($95 to $300 per month) and initial administrative fee. Medical services such as wound cleaning, blood glucose test, and medical check-up may also be charged (Consumer Council, 2015, September 15).

References:

Consumer Council. (2015, September 15). Huge Difference among Residential Care Homes Charge with Various Miscellaneous Items – CHOICE #467 [Press release]. Retrieved from https://www.consumer.org.hk/ws_en/news/press/elderlyhome_0915.html

Sau Po Centre on Ageing. (2011). Consultancy Study on Community Care Services for the Elderly: Final Report. Retrieved from Hong Kong: https://www.elderlycommission.gov.hk/en/download/library/Community%20Care%20Services%20Report%202011_eng.pdf

Social Welfare Department. (2019, November 7). Residential Care Services for the Elderly. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_residentia/

Social Welfare Department. (2020, February 3). The Pilot Scheme on Residential Care Service Voucher for the Elderly. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_residentia/id_psrcsv/

Social Welfare Department. (2020, January 23). Second Phase of the Pilot Scheme on Community Care Service Voucher for the Elderly (Pilot Scheme). Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_csselderly/id_psccsv/

No, remittances are not relevant for LTC financing in Hong Kong.

The Social Welfare Department is currently updating the assessment tool of Standardised Care Need Assessment Mechanism for Elderly Services (SCNAMES) and reforming the LTC service matching mechanism.

According to the 2019 Policy Address, the Government plans to provide an additional 1,000 service voucher (total up to 8,000) under the Pilot Scheme on Community Care Service Voucher for the Elderly, and an additional 3,000 service quota under Integrated Home Care Services (Frail Cases) (The Chief Executive’s 2019 Policy Address, 2019, October 18). 

References:

The Chief Executive’s 2019 Policy Address. (2019, October 18). Press Conference on Labour and Welfare Policy Highlights. Hong Kong Retrieved from https://gia.info.gov.hk/general/201910/18/P2019101800619_325338_1_1571394513483.pdf.

Census and Statistic Department keeps a good record of the number of persons by industry in Hong Kong. As of September 2019, the size of workforce in residential care service is 33,834 persons (5,777 males and 28,057 females), and that of social work services is 31,812 persons (7,977 males and 23,835 females) (Census and Statistics Department, 2019, September). The types of professions in LTC workforce include social workers, registered nurses, enrolled nurses, physiotherapists / physiotherapist assistants, occupational therapists / occupational therapy assistants, health workers, personal care workers, paramedical staff and ancillary workers. In 2019, Hong Kong had 326 social workers, 568 registered nurses, 190 enrolled nurses, 46 physiotherapists, and 32 occupational therapists per 100,000 population (Nursing Council of Hong Kong, n.d.; Occupational Therapists Board, 2020, January; Physiotherapists Board, 2020, January; Social Workers Registration Board, 2020, February 10).

Particularly for residential care homes, there is a minimum staffing requirement for different levels of staff according to the Residential Care Homes (Elderly Persons) Regulation (Cap 459A). In 2020, the staff to resident ratios in Care and Attention Home of nurses, health workers, personal care workers, and ancillary workers were 1:60, 1:30, 1:20/40/60, and 1:40 respectively (Social Welfare Department, 2020, January).

References:

Census and Statistics Department. (2019, September). Table E005: Number of establishments, persons engaged and vacancies (other than those in the Civil Service) analysed by industry section / industry division.

Nursing Council of Hong Kong. (n.d.). Statistics and Lists of Nurses. Retrieved from https://www.nchk.org.hk/en/statistics_and_lists_of_nurses/statistics/index.html

Occupational Therapists Board. (2020, January). Registration Summary. Retrieved from https://www.smp-council.org.hk/ot/en/content.php?page=reg_reg

Physiotherapists Board. (2020, January). Registration Summary. Retrieved from https://www.smp-council.org.hk/pt/en/content.php?page=reg_reg

Social Welfare Department. (2020, January). Code of Practice For Residential Care Homes (Elderly Persons).  Retrieved from https://www.swd.gov.hk/storage/asset/section/2923/en/CoP_RCHE_Eng_20200101.pdf.

Social Workers Registration Board. (2020, February 10). Statistics on Registered Social Workers.

There is no formal training and qualification system particularly designed for LTC workforce in Hong Kong. Each profession has their own professional training and qualification system. Elderly and LTC services are covered in their training in various extents. Each registered professional belongs to the professional body of their own profession (e.g., Social Workers Registration Board, Nursing Council of Hong Kong, Physiotherapists Board, and Occupational Therapists Board).

For non-professional / frontline staff, Employees Retraining Board and Vocational Training Council organise vocational education and training courses related to the elderly service sector, including certificates in care work and additional relevant courses (The Government of the Hong Kong SAR, 2019, April 3).

References:

The Government of the Hong Kong SAR. (2019, April 3). LCQ8: Manpower situation of the elderly service sector [Press release]. Retrieved from https://www.info.gov.hk/gia/general/201904/03/P2019040300679.htm

The LTC workforce is regulated by the Social Welfare Department in Hong Kong. Each profession belongs to its own professional body of registration as mentioned above. For all subsidised services, service operators must follow the Fund Service Agreement (FSA) in order to receive the Government subvention. For all residential care homes including subsidised and privately funded, they are regulated by the Licensing Scheme for Residential Care Homes for the Elderly under The Residential Care Homes (Elderly Persons) Ordinance (Cap 459) and The Residential Care Homes (Elderly Persons) Regulation (Cap 459A) (Social Welfare Department, 2020, January 8).

References:

Social Welfare Department. (2020, January 8). Licensing Scheme for Residential Care Homes for the Elderly. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_lr/sub_rche/id_introd/

Hong Kong is facing a shortage of LTC staff in professional positions such as nurses, occupational therapists, and physiotherapists, as well as non-professional / frontline positions such as health workers and personal care workers (Working Group on Elderly Services Programme Plan, 2017). With the funding of health care services under the Food and Health Bureau and the funding for LTC services under the Labour and Welfare Bureau, compartmentalised arrangement has led to frequent loss of nursing and allied health staff in LTC to acute care facilities due to the lack of promotion prospects for these professional staff. The lack of medical staff in LTC facilities has also resulted in frequent visits to high cost hospital admissions of residents in long-term care institutions (Yuen, 2014). Moreover, Hong Kong is facing a severe problem of workforce shortage of doctors and nurses. In 2016, the number of doctors and nurses per 1,000 population (1.91 and 7.14) is relatively low when compared to other developed countries such as Singapore (2.31 and 7.20), Japan (2.52 and 9.06), and the UK (2.81 and 9.87) (Legislative Council Secretariat, 2018).

The staff vacancy rate in elderly care homes had soared from about 11% to 18% in 2017 (Zhao, 2019). The number of vacancies in elderly care services nearly tripled to 2,630, accounting for 10% of overall available positions in 2018 (Legislative Council Secretariat, 2019, August 16). The required actual manpower for nursing homes, residential care activities, and social work activities altogether was projected from 43,500 in 2017 to 56,900 in 2027. The projected average annual rate of change is +2.7% (Census and Statistics Department, 2019d). To attract more LTC workforce, the Social Welfare Department has launched the Navigation Scheme for Young Persons in Care Services (the Navigation Scheme) starting from July 2015 to encourage young people to join the elderly and rehabilitation care services. As of December 2018, a total of 1,018 trainees have been recruited by service operators of the Navigation Scheme. It is expected that a total of 1,200 training places will be provided in five years starting from 2020-2021 (The Government of the Hong Kong SAR, 2019, April 3).

References:

Census and Statistics Department. (2019d). Report on Manpower Projection to 2027. Retrieved from https://www.statistics.gov.hk/pub/B1050016E2019XXXXE0100.pdf

Legislative Council Secretariat. (2018). Research Brief Issue No. 2 2017 – 2018 – The 2018-2019 Budget. Hong Kong: Legislative Council, HKSAR Retrieved from https://www.legco.gov.hk/research-publications/english/1718rb02-the-2018-2019-budget-20180412-e.pdf.

Legislative Council Secretariat. (2019, August 16). Supplementary Labour Scheme. Retrieved from https://www.legco.gov.hk/research-publications/english/1819issh29-supplementary-labour-scheme-20190816-e.pdf.

The Government of the Hong Kong SAR. (2019, April 3). LCQ8: Manpower situation of the elderly service sector [Press release]. Retrieved from https://www.info.gov.hk/gia/general/201904/03/P2019040300679.htm

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

Yuen, P. P. (2014). Financing Health Care and Long-term Care in a Rapidly Ageing Context: Assessing Hong Kong’s Readiness. Public Policy and Administration, 17(1), 56-64.

Zhao, S. (2019). Hong Kong welfare secretary says elderly care homew will not turn to foreign domestic helpers to fill the labout shortage. South China Morning Post. Retrieved from https://www.scmp.com/news/hong-kong/hong-kong-economy/article/2189344/hong-kong-welfare-secretary-says-elderly-care-homes

Not a major role in Hong Kong currently, as only private elderly care services can import non-local workers (Legislative Council Secretariat, 2019, August 16). The Labour Department has rolled out the Supplementary Labour Scheme (SLS) for employers to import workers when they are unable to find suitable staff locally. A total of 1,383 elderly care workers came in under the programme in 2016. A total of 1,510 imported care workers (mainly from mainland China) were working as care workers in private Residential Care Homes in 2017-2018. The Government is considering the possibility of increasing flexibility to import care workers for subsidised elderly care services as well (The Government of the Hong Kong SAR, 2019, April 3).

References:

Legislative Council Secretariat. (2019, August 16). Supplementary Labour Scheme. Retrieved from https://www.legco.gov.hk/research-publications/english/1819issh29-supplementary-labour-scheme-20190816-e.pdf.

The Government of the Hong Kong SAR. (2019, April 3). LCQ8: Manpower situation of the elderly service sector [Press release]. Retrieved from https://www.info.gov.hk/gia/general/201904/03/P2019040300679.htm

The employment of every Hong Kong resident is protected under the Employment Ordinance (Cap 57), including payment, paid leave, medical attention, and maternity protection.

With the efforts of Social Welfare Department, voluntary works in Hong Kong become systemic and popular. It has spearheaded a territory-wide ‘Volunteer Movement’ since 1998 to encourage more people from all sectors to take part in volunteering. As of the end of March 2017, 1.32 million individuals and 3,394 organisations have registered to join volunteer services and delivered more than 25.8 million hours of volunteer services across all kinds of community services and sources of volunteer in 2018 (Volunteer Movement, n.d.).

Voluntary services currently provided to elderly people in Hong Kong, are mainly focused on non-caregiving services. Several regular, integral, and quite organised volunteer trainings are identified such as Senior Citizen Home Safety Association, Hong Kong Jockey Club Volunteer Team, China Light Power Limited Voluntary Team, and Hong Kong Fire Services Department Volunteer Team. The volunteer services mainly focus on organising leisure and cultural activities, providing supporting work at the voluntary organisations, conducting regular home visits, organising special projects such as home cleaning and electric equipment repairs, conducting health talks and other health promotional activities (Lau & Chan, 2018).

References:

Lau, T.-l., & Chan, K.-y. (2018). Contributions of volunteers in long-term care in Hong Kong. In Sustainable Health and Long-Term Care Solutions for an Aging Population (pp. 216-236): IGI Global.

Volunteer Movement. (n.d.). Volunteer Movement. Retrieved from https://volunteermovement.hk/en/about-volunteer-movement

Carer training programmes and support services, such as counselling services, mutual support groups and group-based psychosocial interventions are widely available in Hong Kong and are provided by all publicly funded community care service units operated by NGOs including elderly community centres, day care centres, and home care teams. Home care teams even provide on-site training at the carer’s home when necessary. Furthermore, since the implementation of the carer allowance scheme, the coverage of carer training programmes and the support services have been further broadened, therefore, social workers at elderly community centres (i.e., District Elderly Community Centres) can reach more carers in need. Although these training programmes are not necessarily dementia-specific, dementia is a common and recurrent training topic.

In addition, the dementia-specific carer training programme is delivered under the territory-wide Dementia Community Support Scheme. One of the core services of the scheme is the “provision of training and support services to the carers on stress management and counselling services, knowledge of taking care of elderly people with dementia, formation of carer support groups, etc. with a view to alleviating carers’ burden” (Food and Health Bureau, 2019a). For more details about Dementia Community Support Scheme, please refer to Part 7.

Moreover, for financial support, under the carer allowance scheme in Hong Kong, low-income family carers will receive HK$2,400 per month to supplement their living expenses.

For more information about unpaid care in Hong Kong, please refer to Part 8.

References:

Food and Health Bureau. (2019a, 4 June, 2019). Dementia Community Support Scheme. Retrieved from https://www.fhb.gov.hk/en/press_and_publications/otherinfo/180500_dcss/dcss_index.html

Dementia is formally recognised within the portfolio of health care and long-term care under the Government, as for being responsible for providing healthcare services, community-based, and residential care to older people with dementia.

In Hong Kong, the Government adopts a multi-disciplinary and cross-sectoral approach in the provision of holistic care to people with dementia. From prevention and early detection to provision of treatment and long-term care, different parties of the government including Food and Health Bureau (FHB), Labour and Welfare Bureau (LWB), Hospital Authority (HA), Department of Health (DH), and Social Welfare Department (SWD) are responsible for dementia. For healthcare, HA provides medical services to older people with dementia, including in-patient and out-patient care, day rehabilitation training, and community support services. For long-term care, SWD provides a range of support to older people with dementia and their family carers, including day care, residential care, community care, and carer support services (Food and Health Bureau, 2017a; Legislative Council Secretariat, 2017, February 21).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Legislative Council Secretariat. (2017, February 21). Care services for elderly persons with dementia. Retrieved from https://www.legco.gov.hk/research-publications/english/essentials-1617ise10-care-services-for-elderly-persons-with-dementia.htm

Dementia is primarily included in the branch of social services and mental health of the Government.

Currently, there is no dementia-specific government unit or representative that is responsible for the formulation of policies on the awareness, treatment, and care of dementia. As mentioned above, the government sectors provide a variety of services to older people including those with dementia.

There is no dementia-specific national document, policy, or plan for reducing the burden attributable to dementia in Hong Kong.

Not applicable, Hong Kong does not have any dementia-specific national document.

Not applicable, Hong Kong does not have any dementia-specific national document.

Not applicable, Hong Kong does not have any dementia-specific national document.

Not applicable, Hong Kong does not have any dementia-specific national document.

Not applicable, Hong Kong does not have any dementia-specific national document.

Not applicable, Hong Kong does not have any dementia-specific national document.

Currently, there is no legislation specifically for protection against elder abuse in Hong Kong. The Social Welfare Department (SWD) refers to the Domestic and Cohabitation Relationships Violence Ordinance (Cap. 189) in their Procedural Guidelines for Handling Elder Abuse Cases (Revised 2019) to unify the definition and equip various professionals on handling suspected elder abuse case (Legislative Council Secretariat, 2017, February 21).

References:

Legislative Council Secretariat. (2017, February 21). Care services for elderly persons with dementia. Retrieved from https://www.legco.gov.hk/research-publications/english/essentials-1617ise10-care-services-for-elderly-persons-with-dementia.htm

There is no dementia-specific strategy in planning and provision of support services for older people with dementia.

However, dementia is covered by the health care and long-term care policy in Hong Kong. Starting from 2014-2015, the Government has provided Dementia Supplement (DS) on a recurrent amount of about $230 million annually as additional support for dementia care in residential care homes to employ additional professional staff. Also, an additional recurrent funding of about $22 million annually was allocated for District Elderly Community Centres (DECCs) to employ more social workers to strengthen the support for older people with dementia and their family carers. Besides, the Hospital Authority (HA) has allocated an additional funding of $12 million to increase the use of new anti-dementia drugs and about 2,700 patients benefited from it (Secretary for Labour and Welfare, 2017, June 27; The Government of the Hong Kong SAR, 2015, June 17).

Apart from the existing financial allocation on services for dementia care, the Government has conducted reviews on the service provision for older people with dementia through an expert group of the Review Committee on Mental Health under the Food and Health Bureau (FHB) since 2013. Also, the 2014 Policy Address has announced that the Elderly Commission under the Labour and Welfare Bureau (LWB) should review and strengthen the medium and long-term care planning for older people including dementia as one of the main issues. In 2017, the Mental Health Review Report (MHRR) and the Elderly Services Programme Plan (ESPP) have been submitted to the Government. Afterwards, the Government has been implementing follow-up actions according to the strategic directions and recommendations in the MHRR and ESPP (Legislative Council Secretariat, 2017, February 21).

In the 2017 Policy Address, the Government has announced a series of new initiatives to enhance dementia care and support at the community level, including outreaching services and additional 1,000 Community Care Service Voucher for the Elderly to older people with moderate or severe impairment. The Financial Secretary has allocated about $2.9 billion for strengthening elderly and rehabilitation services, including territory-wide public education on dementia, provision of technology products and speech therapy in elderly service units. Besides, the Government has launched the Dementia Community Support Scheme to provide multi-disciplinary community support services through medical-social collaboration for persons with mild or moderate dementia and family carers since 2017 (The Government of the Hong Kong SAR, 2018, July 4).

References:

Legislative Council Secretariat. (2017, February 21). Care services for elderly persons with dementia. Retrieved from https://www.legco.gov.hk/research-publications/english/essentials-1617ise10-care-services-for-elderly-persons-with-dementia.htm

Secretary for Labour and Welfare. (2017, June 27). Panel on Welfare Services and Panel on Health Services, Joint Subcommittee on Long-term Care Policy, Follow-up to the meeting on 28 March 2017. Hong Kong Retrieved from https://www.legco.gov.hk/yr16-17/english/panels/ltcp/papers/ltcp20170328cb2-1748-1-e.pdf

The Government of the Hong Kong SAR. (2015, June 17). LCQ16: Dementia [Press release]. Retrieved from https://www.info.gov.hk/gia/general/201506/17/P201506170682.htm

The Government of the Hong Kong SAR. (2018, July 4). LCQ17: Elderly Services Programme Plan [Press release]. Retrieved from https://www.info.gov.hk/gia/general/201807/04/P2018070400621.htm

Dementia is covered in the areas of mental health and long-term care according to the Mental Health Review Report (MHRR) and Elderly Services Programme Plan (ESPP).

• The Mental Health Review Report (MHRR)

There is a chapter on dementia support services for the elderly (Chapter 4), which describes the burden of dementia, existing services for people with dementia, enhancing dementia care through person-centered and holistic care approaches, integrated community care and intervention model for dementia, and recommendations for dementia care. To reduce the existing service gaps, it recommends the enhancement of public education and prevention, primary and specialist care, post-diagnostic medical, community and residential support services, training of care workforce, and legal protection for people with dementia and their family carers (Food and Health Bureau, 2017a).

• Elderly Services Programme Plan (ESPP)

There is a chapter describing the services for elderly persons (Chapter 5) including dementia as one of the subchapters. It proposes two recommendations in relation to dementia care. Based on the two recommendations, a closer medical-social collaboration should be encouraged in the provision and future development of dementia services, such as public education, carer training, and staff training. It also recommends the enhancement of knowledge and skills among older people, family carers and care workers in the early detection of dementia (including mild cognitive impairment) and timely referral to appropriate services at the community care levels (Working Group on Elderly Services Programme Plan, 2017).

• “Recommendation 10 – Services for elderly persons with dementia should be strengthened. The issue of dementia should be considered as an integral part in the whole spectrum of elderly services and a multidisciplinary approach should be adopted.”
• “Recommendation 19 – The interface between mainstream elderly services and existing services for people from minority groups or people with special needs should be strengthened to enable provision of suitable support for service users from different backgrounds.”

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

There is no dementia-specific document operationalised at subnational levels in Hong Kong.

Dementia is framed as one of the major mental health conditions in the official mental health service review, and one of the key service areas in the official elderly service plan. In the Mental Health Review Report (MHRR) there are three main chapters on mental health services including children and adolescents (Chapter 2), adults (Chapter 3), and dementia support services for the elderly (Chapter 4). Dementia is covered in one of the chapters. In the Elderly Services Programme Plan (ESPP), Chapter 5 describes the six areas of elderly services including active ageing, community care services and carer support, residential care services, Standardised Care Need Assessment Mechanism and case management, services for elderly persons with dementia, and end-of-life care. Dementia is covered in one of the areas and two corresponding recommendations are proposed among a total of 20 short, medium to long-term recommendations on elderly care services (Food and Health Bureau, 2017a; Working Group on Elderly Services Programme Plan, 2017).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The Mental Health Review Report (MHRR) indicates that persons with dementia are under legal protection according to the Mental Health Ordinance (MHO) (Cap 136) and the Enduring Powers of Attorney Ordinance (Cap 501). These ordinances guarantee and protect the rights of people with mental illness including dementia throughout the process of illness and recovery. Persons with dementia can appoint a guardian or an attorney when they are still mentally capable. This guardian or attorney can help take care and make decisions for their welfare and financial affairs (Food and Health Bureau, 2017a, p. 160). The wishes of persons with dementia and their family members should be respected under the ordinances (Food and Health Bureau, 2017a, p. 172).

The Elderly Services Programme Plan (ESPP) highlights the principle on dignity of older people. They deserve the respect of others as a member of the community (Working Group on Elderly Services Programme Plan, 2017, p. 13).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

Equity is not clearly outlined in the existing plans. The Mental Health Review Report (MHRR) lists out the principles identified by the World Health Organization (WHO) which include embracing an equity-based approach in accessing health care and social care services for persons with dementia and their family carers (Food and Health Bureau, 2017a, p. 141).

In addition, the Elderly Services Programme Plan (ESPP) mentions the principle of social inclusion and equal opportunity. Older people with diverse backgrounds, differing languages, cultures and religions should have equal access to all kinds of services (Working Group on Elderly Services Programme Plan, 2017, p. 14).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The Mental Health Review Report (MHRR) lists out the principles identified by the WHO which include empowering the full and active participation of persons with dementia and their family carers to overcome stigma and discrimination (Food and Health Bureau, 2017a, p. 141). This report also indicates the need for information and community resources to empower carers on their competence to perform care tasks and maintain their caring roles (Food and Health Bureau, 2017a, p. 143).

Moreover, the Elderly Services Programme Plan (ESPP) mentions the principles of active and productive ageing of older people. It promotes the participation of older people to the society and empower them in continuous and self-directed learning, volunteer activities, and flexible retirement mechanisms (Working Group on Elderly Services Programme Plan, 2017, pp. 22-23)

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The Mental Health Review Report (MHRR) emphasises the need to develop a more refined model for integrated community care and intervention by making a better use of public and private resources for dementia care among the cross-sectoral collaboration between government departments, NGOs, and private sectors. Healthcare professionals at primary and specialist levels (e.g., doctors, social workers, nurses, occupational therapists, physiotherapists, programme assistants) should be involved in the care pathway for dementia patients, including early assessment, case management, and intervention (Food and Health Bureau, 2017a, pp. 175-180).

The Elderly Services Programme Plan (ESPP) mentions the strategic directions on promoting inter-sectoral, inter-department, inter-disciplinary, and inter-agency collaboration, especially between welfare, healthcare and housing sectors, to achieve seamless and integrated care service delivery for older people (Working Group on Elderly Services Programme Plan, 2017, p. 14).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

As mentioned in the Mental Health Review Report (MHRR), the Government has been providing a wide range of support for people with dementia and their family carers, including preventive, diagnostic, primary, specialist, and social care services. For subsidised services, they include community care, residential care, medical outreach, and respite services. It also provides dementia supplement for increasing professional staff and care facilities in day care units and residential care homes for the elderly (Food and Health Bureau, 2017a, p. 155). It also lists out the principles identified by WHO which include embracing the universal health coverage in accessing health care and social care services for people with dementia and their family carers (Food and Health Bureau, 2017a, p. 141).

The Elderly Services Programme Plan (ESPP) recommends the strengthening of service coverage for older people according to their age-related needs (Working Group on Elderly Services Programme Plan, 2017, p. 21).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The Mental Health Review Report (MHRR) and the Elderly Services Programme Plan (ESPP) can reflect one of the sustainable development goals, which is “Goal 3 – Good health and well-being: Ensure healthy lives and promote well-being for all at all ages”. This emphasises on putting more efforts to fully eradicate a wide range of non-communicable diseases and address the growing burden of different health issues, including child health, maternal health, HIV/AIDS, malaria, and other diseases. Two of the 13 targets stated in Goal 3 are related to MHRR and ESPP (United Nations, n.d.).

• “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”
• “Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.”

References:

United Nations. (n.d.). Good Health and Well-Being: Why it Matters.

The Mental Health Review Report (MHRR) mentions the needs of family carers identified by WHO while including information on dementia and community resources, physical care assistance, training on how to take care of persons with dementia, respite services, emotional support, recognition, and financial assistance (Food and Health Bureau, 2017a, p. 144). Physical care assistance and emotional support are identified as the major support for family carers (Food and Health Bureau, 2017a, p. 169). The Government has provided and have subsidised support for carers, including day and residential respite services, skill training and education, living expenses allowance, and accessible information resources (Food and Health Bureau, 2017a, p. 159). Since family carers usually take care of persons with dementia at the primary role, it is particularly important to help them recognise the signs of illness and provide structured advice along the continuum of care at different stages of dementia. Grieve and bereavement support are also needed in the end-of-life care process (Food and Health Bureau, 2017a, p. 172).

The Elderly Services Programme Plan (ESPP) proposes strategic directions to increase quality of life, age-friendliness, informed choice and timely access to quality services for older people and their family carers (Working Group on Elderly Services Programme Plan, 2017, p. 13).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The risk of mistreatment and abuse of people with dementia is not clearly covered in the existing plans. The Mental Health Review Report (MHRR) only mentions the Visiting Health Teams (VHTs) under the Department of Health which delivers on-site education and training in elderly community and residential care settings on a wide range of topics, including prevention of elder abuse, building cognitive reserve, and skills for the caring of elders with dementia (Food and Health Bureau, 2017a, p. 41).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

As mentioned in the Mental Health Review Report (MHRR), the Government has provided different support for people with dementia and their family carers based on the principles of age in place. This emphasises on increasing awareness, reducing stigma, enhancing early detection and intervention, and strengthening community support to allow people with dementia living safely, independently, and comfortably in the community (Food and Health Bureau, 2017a, p. 168). It also recommends that the Government should further strengthen social care infrastructure in order for persons with dementia to remain in the community for as long as possible (Food and Health Bureau, 2017a, p. 188).

The Elderly Services Programme Plan (ESPP) recommends the enhancement of community care support to achieve the principle of age in place and avoid unnecessary institutionalisation (Working Group on Elderly Services Programme Plan, 2017, p. 24).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

As mentioned in the Mental Health Review Report (MHRR), a person-centred and holistic care model is required to be accessible, individualised and responsive to the multiple and changing needs at different stages of dementia (Food and Health Bureau, 2017a, p. 168). The Government has been working to develop a dementia-friendly community. The first step is to remove risk factors and to make a friendly design of housing, such as removal of harmful substances and sharp objects, using clear signs with contrast to highlight the contents and making facilities easy to use in the community. Besides, it also recommends education to non-healthcare professionals to understand dementia, especially for police and security guards who have an important role in finding persons with dementia when they gone missing from home. A more accepting and supportive neighbourhood can promote self-management of persons with dementia at home and in the community (Food and Health Bureau, 2017a, p. 171).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf

As mentioned in the Mental Health Review Report (MHRR), persons with dementia and their family members can appoint a guardian or an attorney to make decisions on financial, legal, and healthcare arrangements for them under the two ordinances of legal protection as previously mentioned.

The Elderly Services Programme Plan (ESPP) mentions the principle of enabling informed choices with adequate and updated information provided to older people which match their varying needs, such as the quality, quantity, fees, and location of different services units (Working Group on Elderly Services Programme Plan, 2017, p. 13).

References:

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

As mentioned in the Mental Health Review Report (MHRR), an effective medical-social collaboration is essential to achieve a person-centred and holistic care model to ensure the quality of nursing and personal care in health and social care services (Food and Health Bureau, 2017a, p. 171).

The Elderly Services Programme Plan (ESPP) recommends the development of a comprehensive quality assurance system to monitor the quality and make continuous improvement for elderly services (Working Group on Elderly Services Programme Plan, 2017, p. 25). This plan also suggests measures to strengthen the quality of community and residential care services, reviews Residential Care Homes (Elderly Persons) Ordinance (Cap 459), and encourges public-private partnership in service provision (Working Group on Elderly Services Programme Plan, 2017, pp. 28-29).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The Mental Health Review Report (MHRR) recommends the Government to increase the supply and structured trainings for health and social care providers (e.g., social workers, nurses, occupational therapists, physiotherapists, programme assistants, etc.) to empower them with equipped necessary skills and knowledge in dementia care (Food and Health Bureau, 2017a, pp. 186-187). It also mentions the need to pilot the programme in order to test the readiness of service providers on clinical effectiveness, cost economic analysis, and service statistics (Food and Health Bureau, 2017a, p. 186). In the part of capacity building and workforce training, this report recommends that structured training should be given to empower service providers in detecting dementia symptoms, understanding the disease trajectory, and developing dementia care approaches (Food and Health Bureau, 2017a, p. 172).

The Elderly Services Programme Plan (ESPP) indicates the demand for long-term care services and workforce to address the increasing population of older people. Apart from ongoing measures to strengthen the workforce, it is also important to explore other sources of informal care providers, such as neighbours and volunteers who can serve as “elder-sitters” to support older people in the community (Working Group on Elderly Services Programme Plan, 2017, pp. 32-34).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The Mental Health Review Report (MHRR) proposes a seven-stages model for dementia service planning promulgated by the WHO and the Alzheimer’s Disease International. The service needs and major service providers (i.e., key actors) in each stage of dementia care (Food and Health Bureau, 2017a, p. 151):

1. Pre-diagnosis

• Service needs: public education & prevention
• Major service providers: Department of Health (DH), Hospital Authority (HA), Social Welfare Department (SWD), NGOs, carers, private doctors

2. Diagnosis

• Service needs: primary & specialist care
• Major service providers: HA, private doctors

3. Post-diagnostic support

• Service needs: primary & specialist care; community & information support
• Major service providers: HA, SWD, NGOs, carers, private doctors

4. Coordination & care management

• Service needs: primary & specialist care; community support; needs assessment
• Major service providers: HA, SWD, NGOs, carers, private doctors

5. Community services

• Service needs: specialist care; community support; outreach services; carer training
• Major service providers: HA, SWD, NGOs, DH, carers

6. Continuing care

• Service needs: acute & sub-acute medical services; hospital care; community support
• Major service providers: HA, SWD, NGOs, carers

7. End-of-life palliative care

• Service needs: acute & sub-acute medical services; continuing & palliative care
• Major service providers: HA, SWD, NGOs, carers.

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

The Mental Health Review Report (MHRR) proposes an integrated community care and intervention model for persons with dementia (Food and Health Bureau, 2017a, p. 171). It emphasises the need for bilateral and integrated support by health professionals in primary and specialist care for dementia. It recommends that medical-social collaboration should be enhanced to integrate the delivery of medical, community, residential, as well as psychosocial care services to provide patient-centred support and bring the best possible outcomes in dementia care in the long run (Food and Health Bureau, 2017a, pp. 175-180).

The Elderly Services Programme Plan (ESPP) proposes a recommendation that dementia should be integrated in the whole spectrum of elderly services and a multi-disciplinary approach should be adopted by especially with a closer collaboration between the healthcare system and welfare sector for dementia (Working Group on Elderly Services Programme Plan, 2017, p. 30).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The Mental Health Review Report (MHRR) outlines the burden of dementia, health and social care services for persons with dementia and their family carers, approaches to enhance dementia care, integrated community care and intervention model for dementia, and recommendations for dementia care (Food and Health Bureau, 2017a).

The Elderly Services Programme Plan (ESPP) covers the principle of active ageing, community care services and carer support, residential care services, assessment mechanism and case management, dementia care services, and end-of-life care for older people. In terms of collaboration, partnership, and interfacing with other sectors, it recommends more effective partnerships between welfare, healthcare, and housing sectors. To meet the diverse needs and expectations of the elderly population, it emphasises the interface between multiple providers of services among various sectors, including subsidised services, self-financed services, and private services (Working Group on Elderly Services Programme Plan, 2017, p. 40).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The Mental Health Review Report (MHRR) recognises some potential barriers to access the existing dementia care services. First, the post-diagnostic medical and community support services for dementia need a long waiting time. Firstly, lack of coordination among service providers in delivering stepped-down care for persons with dementia, is a key issue. Secondly, the current assessment mechanism is not dementia-specific for determining suitable dementia-oriented care services. Lastly, the diagnosis and post-diagnostic secondary or tertiary medical support for younger onset of dementia is often delayed due to inadequate recognition of symptoms by clinicians (Food and Health Bureau, 2017a, p. 162). To overcome these barriers, the implementation of a refined intervention model is recommended to facilitate timely intervention for persons with dementia. Primary care setting can be used as a proper gate-keeping and dementia cases can be transferred to community setting for ongoing management. Enhancing capacity in secondary care, shorten the waiting times, and more effective use of specialist services would be helpful interventions (Food and Health Bureau, 2017a, p. 186).

The Elderly Services Programme Plan (ESPP) recommends the set-up of a real-time vacancy information system and district-based pre-registration system to reduce the barriers of service utilisation and facilitate timely access to service, especially for respite and emergency placement services (Working Group on Elderly Services Programme Plan, 2017, pp. 24-25). It also recommends the need to improve the current assessment mechanism for better service matching and develop a case management model for better coordination among different services (Working Group on Elderly Services Programme Plan, 2017, p. 29).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

As mentioned in the Mental Health Review Report (MHRR), there is a wide range of subsidised support and care services provided to persons with dementia and their family carers. In terms of financial risk protection, the Government has launched the Pilot Schemes on Living Allowance for Carers of Elderly Persons from Low-income Families since 2014. Under this scheme, a total of 4,000 carers including carers for persons with dementia were benefited as of 2018 (Food and Health Bureau, 2017a, p. 159).

In terms of equitable access and affordability, the Elderly Services Programme Plan (ESPP) proposes recommendations on strengthening the financial sustainability of elderly services through reviewing the existing co-payment and allowance schemes (Working Group on Elderly Services Programme Plan, 2017, p. 40).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

As mentioned in the Mental Health Review Report (MHRR), the prevention of dementia can be divided in three conventional levels. On one hand, to delay the onset of dementia, primary prevention consists of public education and risk reduction measures to promote healthy lifestyles, social engagement, and cognitive reserve. On the other hand, secondary prevention includes both pharmacological and non-pharmacological means for detection, diagnosis, intervention, and supportive services to manage the cognitive decline and progression of dementia. Moreover, tertiary prevention includes accurate and individualised need assessment to reduce the burden and to improve quality of life for persons with dementia and their family carers (Food and Health Bureau, 2017a, p. 186).

The Elderly Services Programme Plan (ESPP) mentions not only strategic directions on strengthening health maintenance, but also risk reduction and illness prevention by providing suitable services to older people with mild impairments (Working Group on Elderly Services Programme Plan, 2017, p. 24).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

As mentioned in the Mental Health Review Report (MHRR), it is important to develop effective medical-social collaboration and intervention model while addressing the rising demand of dementia care services in a more cost-effective and sustainable way (Food and Health Bureau, 2017a, p. 186).

In terms of ensuring financial sustainability and accountability, the Elderly Services Programme Plan (ESPP) proposes the review of existing funding models of public expenditures, co-payments and allowance schemes for community and residential care services for older people. This plan also considers exploring measures to facilitate the provision of self-financing services from NGOs and alternative long-term care financing options based on the varying levels of needs, aspirations, and affordability of elderly services users (Working Group on Elderly Services Programme Plan, 2017, p. 40).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

Currently, there is no dementia-specific policy or plan in Hong Kong.

Nevertheless, the Mental Health Review Report (MHRR) and the Elderly Services Programme Plan (ESPP) provide holistic reviews and recommendations on existing services including dementia care. They identify several stakeholders with different roles to cooperate together in addressing the complex needs of dementia care from prevention and diagnosis to timely intervention and long-term care. These stakeholders involve the Food and Health Bureau (FHB), Labour and Welfare Bureau (LWB), Hospital Authority (HA), Department of Health (DH), Social Welfare Department (SWD), and other relevant parties, such as NGOs, private doctors, formal and informal carers. The ESPP proposes recommendations about the Government which should have a regular track on the goals and objectives in planning, implementing, and evaluating elderly services with adequate participation among stakeholders at district level and territory-wide levels (Working Group on Elderly Services Programme Plan, 2017, p. 44). However, there is no clear descriptions about the specific roles of different stakeholders and how they monitor the progresses to achieve tangible outcomes.

References:

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

There is no clear monitoring mechanism for the targets or recommendations suggested in the Mental Health Review Report (MHRR) and the Elderly Services Programme Plan (ESPP).

In the Mental Health Review Report (MHRR), there are some major service gaps identified in the current delivery model of dementia care which require further actions for improvement. These services gaps and actions to bridging the gaps in the seven-stage model for dementia service planning are (Food and Health Bureau, 2017a, p. 186):

1. Pre-diagnosis

• Service gaps: awareness; knowledge; early detection
• Actions: territory-wide epidemiological studies; public education; care worker training

2. Diagnosis

• Service gaps: tests & scans for dementia; long waiting time; younger onset dementia
• Actions: coordinate primary, secondary & specialist care; share electronic health record

3. Post-diagnostic support

• Service gaps: difficult to access service & handle crisis
• Actions: clear pathways of referral; advice on treatment options; hotline service

4. Coordination & care management

• Service gaps: unclear coordination among service providers in the neighbourhood
• Actions: case management; identify special needs; database to review outcomes

5. Community services

• Service gaps: no dementia-specific services
• Actions: more day care, respite, outreach & home-based services; carer training

6. Continuing care

• Service gaps: inadequate support to promote longer living in the community
• Actions: strengthen medical & long-term care; discharge planning; care worker training

7. End-of-life palliative care

• Service gaps: not widely understood among the public
• Actions: promote greater acceptance; legal issues in making informed decisions.

Regarding evidence of achievement, for 5. Community services, a dementia-specific community service, namely Dementia Community Support Scheme, was piloted for 2 years starting from 2017 and became regularised in 2019.

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

The Mental Health Review Report (MHRR) and the Elderly Services Programme Plan (ESPP) were developed by a wide range of stakeholders from different sectors, including (Food and Health Bureau, 2017a; Working Group on Elderly Services Programme Plan, 2017):

Health care

• Hospital Authority Dr CHEUNG Wai-lun
• Hospital Authority Dr CHAN Hon-wai, Felix
• Hospital Authority Dr TSE Man-wah, Doris
• Kwai Chung Hospital Dr SHUM Ping-shiu
• Health Services Functional Constituency Prof Hon LEE Kok-long, Joseph

Health & social care

• Haven of Hope Christian Services Dr LAM Ching-choi

Social care (NGO)

• Hong Kong Alzheimer’s Disease Association Dr DAI Lok-kwan, David
• Hong Kong Association of Gerontology Dr LEUNG Man-fuk, Edward
• Senior Citizen Home Safety Association Mr MA Kam-wah, Timothy
• New Life Psychiatric Rehabilitation Association Ms YAU Sau-wai, Sania
• Hong Kong Council of Social Service Miss CHAN Man-yee, Grace
• The Hong Kong Council of Social Service Ms WONG Yiu-ming, Anita
• The Hong Kong Council of Social Service Dr CHENG Lai-ling, Crystal
• Social Welfare Functional Constituency Mr CHEUNG Kwok-che
• International Social Service Hong Kong Branch Mr YAU How-boa, Stephen
• Po Leung Kuk Mrs WONG WONG Yu-sum, Doris
• Hong Kong Sheng Kung Hui Welfare Council Limited Ms CHOW Mee-tim
• Hong Kong Carers Alliances Dr LAW Kam-chu, Gemma

Social care (Private sector)

• Tung Hoi Association for the Gifted Child Limited Mr LEE Pak-ying Richard
• Hiu Kwong Nursing Service Limited Mr SHIE Wai-hung, Henry
• Bunhoi Group Mr WONG Fan-foung, Jackson
• T.Investment Limited Mr CHAN Chi-yuk, Kenneth

Public education & Voluntary service

• The Hong Kong Association of Senior Citizens Mrs CHAN LUI Ling-yee, Lilian

Housing

• Hong Kong Housing Society Dr CHEUNG Moon-wah

Academics

• The Chinese University of Hong Kong Prof CHIU Fung-kum, Helen
• The Chinese University of Hong Kong Prof LAM Chiu-wa, Linda
• The University of Hong Kong Dr LOU Wei-qun, Vivian
• The University of Hong Kong Dr YEUNG Ka-ching
• The Hong Kong Polytechnic University Prof FUNG Yuk-kuen, Sylvia
• City University of Hong Kong CHONG Ming-lin, Alice
• Lingnan University Prof CHAN Cheung-ming, Alfred

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

There is no clear content about the expectations of different stakeholders who participated in developing the Mental Health Review Report (MHRR) and the Elderly Services Programme Plan (ESPP).

The Mental Health Review Report (MHRR) proposes two recommendations on increasing public education and dementia-friendly neighbourhood.

• “Recommendation 1 – Public education should be strengthened by promoting healthy lifestyles, better understanding and awareness of dementia, encouraging help-seeking behaviour and reducing stigma associated with dementia” (Food and Health Bureau, 2017a, p. 184).
• “Recommendation 7 – Social care infrastructure should be strengthened to allow people with dementia to remain in the community for as long as possible” (Food and Health Bureau, 2017a, p. 188).

The Elderly Services Programme Plan (ESPP) proposes two recommendations about promoting age-friendly environment, healthy lifestyle, and active social participation amongst older people.

• “Recommendation 1 – Public education should be strengthened to promote positive image of elderly persons, enhance their status and role in society, and foster positive inter-generational relations” (Working Group on Elderly Services Programme Plan, 2017, p. 20).
• “Recommendation 3a – Promotion of healthy lifestyle should be of paramount importance in improving the quality of life of elderly persons and in reducing the risk of age-related diseases” (Working Group on Elderly Services Programme Plan, 2017, p. 20).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The Elderly Services Programme Plan (ESPP) proposes a recommendation on strengthening health maintenance, risk reduction, and illness prevention.

• Recommendation 4a – “For the prevention of health deterioration, the provision of suitable services to elderly persons with mild impairments should be strengthened, such as through enhancing Integrated Home Care Services (Ordinary Cases) in order to focus on these elderly persons” (Working Group on Elderly Services Programme Plan, 2017, p. 24).

References:

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The Mental Health Review Report (MHRR) reveals that there is inadequate expertise and capacity in early diagnosis and post-diagnostic support of dementia in primary care setting (Food and Health Bureau, 2017a, p. 161). The report proposes five recommendations on promoting timely diagnosis, intervention, and best practices in managing different stages of dementia.

• “Recommendation 3 – A common reference should be developed to support primary care professionals on the diagnosis and management of dementia” (Food and Health Bureau, 2017a, p. 186).
• “Recommendation 4 – The role of primary care in the provision of dementia care should be enhanced through capacity building” (Food and Health Bureau, 2017a, p. 186).
• “Recommendation 5 – The capacity of specialist services in HA should be strengthened to facilitate timely intervention of dementia cases through the implementation of a refined intervention model, while reducing the waiting times of specialist services” (Food and Health Bureau, 2017a, p. 187).
• “Recommendation 8 – It is necessary to enhance medical-social collaboration and further integrate the delivery of healthcare and social care interventions to provide patient-centred support” (Food and Health Bureau, 2017a, p. 188).
• “Recommendation 9 – End-of-life care and palliative care in the community setting should be promoted to minimise unnecessary and repeated hospitalisations” (Food and Health Bureau, 2017a, p. 189).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The Mental Health Review Report (MHRR) proposes recommendations on strengthening workforce training on dementia.

• “Recommendation 6 – There is also a need to increase the supply of healthcare manpower and strengthen their training. Training for healthcare and social care providers should be enhanced so that they are equipped with the necessary skills and knowledge in providing care to persons with dementia”(Food and Health Bureau, 2017a, p. 187).

 The Elderly Service Programme Plan proposes five recommendations on enhancing staff training on dementia detection and sustaining the workforce for elderly services.

• “Recommendation 10(i) – Enhancing workers’ knowledge and skills in early detection of dementia (including mild cognitive impairment cases) in elderly centres at a neighbourhood level and in making timely referrals to appropriate services” (Working Group on Elderly Services Programme Plan, 2017, p. 30).
• “Recommendation 10(ii) – Strengthening training in early detection, management, and care of dementia in elderly service units, particularly in community care services” (Working Group on Elderly Services Programme Plan, 2017, p. 30).
• “Recommendation 12a – Measures to improve recruitment, retention, working condition, and career development of staff in elderly service should be explored” (Working Group on Elderly Services Programme Plan, 2017, p. 32).
• “Recommendation 12b – The structure of professional staff should be fine-tuned to enable more flexible staff deployment and maximisation of staff input” (Working Group on Elderly Services Programme Plan, 2017, p. 33).
• “Recommendation 12d –There should be ongoing monitoring and evaluation of the manpower measures” (Working Group on Elderly Services Programme Plan, 2017, p. 34).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

As mentioned in the Mental Health Review Report (MHRR), coordinated medical and social care services for both persons with dementia and family carers are essential elements for promoting the goal of age in place. The report proposes a recommendation on enhancing support for family carers to allow them to engage in other living activities and continue in their role effectively.

• “Recommendation 10 – Support for carers should be enhanced. This includes providing them with structured and accessible information, skills to assist in caring, respite to enable engagement in other activities so that they can continue in their role effectively” (Food and Health Bureau, 2017a, p. 189).

The Elderly Services Programme Plan (ESPP) proposes four recommendations which promote a greater flexibility, variety, and choices of supportive services, such as the expansion of services to cover odd hours and holidays, in order to meet specific caring needs among older people and their family carers.

• “Recommendation 5a – Designated respite places and casual vacancies should be fully utilised to strengthen the support to carers. Improvement should be made to facilitate timely access to services” (Working Group on Elderly Services Programme Plan, 2017, p. 25).
• “Recommendation 5b – Transitional care support to elderly persons discharged from hospitals should be enhanced to assist them to stay in the community and prevent premature institutionalisation” (Working Group on Elderly Services Programme Plan, 2017, p. 25).
• “Recommendation 5c – Emergency placement services should continue to target on elderly persons with urgent care needs and under unforeseen or crisis situation, such as those with immediate care needs due to social reasons” (Working Group on Elderly Services Programme Plan, 2017, p. 26).
• “Recommendation 5e – Day respite that integrates formal and informal system of care at neighbourhood level should be strengthened” (Working Group on Elderly Services Programme Plan, 2017, p. 26).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

The Elderly Services Programme Plan (ESPP) proposes the set-up of a real-time vacancy information system and district-based pre-registration system to reduce the barriers concerning service utilisation and to facilitate timely access to services, especially for respite and emergency placement services (Working Group on Elderly Services Programme Plan, 2017, p. 24). The plan also proposes two recommendations on improving the information systems for elderly care, including dementia.

• “Recommendation 18a – An integrated service provider interface with the Long Term Care Services Delivery System (LDS) built on the LDS database with enhanced Standardised Care Need Assessment Mechanism for Elderly Services (SCNAMES) functions, is to be explored” (Working Group on Elderly Services Programme Plan, 2017, p. 41).
• “Recommendation 18c – Use of Information and Communication Technology (ICT) should be expanded to enhance the quality of care delivery” (Working Group on Elderly Services Programme Plan, 2017, p. 42).

References:

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

As mentioned in the Mental Health Review Report (MHRR), innovative technology should be strengthened in the daily operation of elderly service units and provision of dementia care services. It becomes helpful to attract young professionals to join the workforce of dementia care as a long-term solution (Food and Health Bureau, 2017a, p. 190). The report also proposes a recommendation on dementia research.

• “Recommendation 2 – Territory-wide prevalence studies of dementia should be conducted regularly to inform service planning” (Food and Health Bureau, 2017a, p. 185).

The Elderly Services Programme Plan (ESPP) indicates the need to further study the service demand for older people with mild impairments (Working Group on Elderly Services Programme Plan, 2017, p. 24). This plan also proposes a recommendation on increasing study to investigate the demand for elderly services.

• “Recommendation 5d – Further study on the demand for respite, transitional care, and emergency placement services should be considered. Moreover, the possibility of better using non-subsidised places to provide such services should be explored” (Working Group on Elderly Services Programme Plan, 2017, p. 26).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

There is no dementia-specific legislation either at the national or subnational level in Hong Kong. Currently, there are provisions in other laws related and applied to protecting the rights of people with impaired mental capacities, including dementia.

There is a universal law on supporting the decision-making of people with mental incapability. The Enduring Powers of Attorney Ordinance (Cap. 501) allows one, while he or she is still mentally capable, to appoint an attorney to take care of his or her financial matters in the event that he or she becomes mentally incapacitated one day (Department of Justice, 2013).

References:

Department of Justice. (2013). Cap. 501 Enduring Powers of Attorney Ordinance. Hong Kong Retrieved from https://www.elegislation.gov.hk/hk/cap501.

There is universal law on protecting the rights of people with mental incapability. The Mental Health Ordinance (Cap. 136) guarantees and protects the rights of people with mental illness throughout the course of illness and recovery, including those who have dementia. A guardian or a committee may be appointed for helping to take care of the property and affairs, as well as the medical and health care of individuals who are mentally incapacitated (Department of Justice, 2019b).

References:

Department of Justice. (2019b). Cap. 136 Mental Health Ordinance. Hong Kong Retrieved from https://www.elegislation.gov.hk/hk/cap136.

There is no dementia-specific or universal legislation aimed at promoting the transition of dementia care to community-based services.

There is universal law on inspecting the human rights conditions or care quality for older people. The Domestic and Cohabitation Relationships Violence Ordinance (Cap. 189) in the Procedural Guidelines for Handling Elder Abuse Cases (Revised 2019) unifies the definition and prepares various professionals on handling suspected elder abuse case (Social Welfare Department, 2020, February 26).

References:

Social Welfare Department. (2020, February 26). Services for Prevention and Handling of Elder Abuse. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_csselderly/id_serabuseelder/

There is universal law on monitoring the use of coercive practices in mental health care and elderly care. The Mental Health Ordinance (Cap. 136) regulates the conditions and circumstances under which mechanical means of restraint or seclusion may be applied to patients (Department of Justice, 2019b). The Residential Care Homes (Elderly Persons) Regulation (Cap. 459A) requires the home manager to maintain records of any action taken, including the use of force or mechanical restraint, to prevent or restrain a resident from injuring himself or others, damaging property, or creating a disturbance (Department of Justice, 2020).

References:

Department of Justice. (2019b). Cap. 136 Mental Health Ordinance. Hong Kong Retrieved from https://www.elegislation.gov.hk/hk/cap136.

Department of Justice. (2020). Cap. 459A RESIDENTIAL CARE HOMES (ELDERLY PERSONS) REGULATION. Hong Kong Retrieved from https://www.elegislation.gov.hk/hk/cap459A.

There is no dementia-specific or universal legislation pertaining to advance care directives in Hong Kong. At present, advance directives have been implemented through administrative measures by Hospital Authority (HA) since 2010 under the common law. Based on self-determination by patients, a standard form along with a detailed guideline from clinicians is used for advance directives, including refusal of life-sustaining treatments, signatures of two witnesses involving a doctor, effective at times of losing mental capacity, and applicability witnessed by non-HA doctors. Since 2012, the Clinical Management System (CMS) has marked advance directives witnessed by HA doctors as a reminder to assist clinical communication. Currently, advance directives cover patients (a) terminally ill; (b) in a persistent vegetative state or a state of irreversible coma; or (c) in other specified end-stage irreversible life limiting condition, which includes patients with irreversible loss of major cerebral function and extremely poor functional status, end-stage renal failure, end-stage motor neuron diseases, and end-stage chronic obstructive pulmonary diseases. However, the public response to advance directives is lukewarm due to low public awareness, reluctance of doctors to certify ADs and other implementation issues. There were only 5,561 advance directives made during 2012-2018. In the 2018 Policy Address, the Government was pledged to consult the public again in 2019 on the future arrangements of advance directives and relevant end-of-life care (Legislative Council Secretariat, 2019, June 6; The Government of the Hong Kong SAR, 2019, May 22).

References:

Legislative Council Secretariat. (2019, June 6). Advance healthcare directives of patients. Retrieved from https://www.legco.gov.hk/research-publications/english/essentials-1819ise07-advance-healthcare-directives-of-patients.htm

The Government of the Hong Kong SAR. (2019, May 22). LCQ15: Advance directives in relation to medical treatment [Press release]. Retrieved from https://www.info.gov.hk/gia/general/201905/22/P2019052200261.htm

There is universal law pertaining to anti-discrimination on persons with disability, including mental incapability. The Disability Discrimination Ordinance (Cap. 487) protects individuals with disability in different areas, including public, employment, education, provision of goods, services and facilities, access, disposal and management of premises, participation in clubs and sporting activities, and activities of the Government (Department of Justice, 2015).

References:

Department of Justice. (2015). Cap. 487 Disability Discrimination Ordinance. Hong Kong Retrieved from https://www.elegislation.gov.hk/hk/cap487.

There is universal law pertaining to anti-discrimination on individuals based on family status, which concerns their responsibility for the care of immediate family members. The Family Status Discrimination Ordinance (Cap. 527) protects people on the basis of family status in different areas, including employment, education, provision of goods, services and facilities, disposal and management of premises, eligibility to vote for and to be elected or appointed to advisory bodies, participation in clubs, and activities of the Government (Department of Justice, 2018).

References:

Department of Justice. (2018). Cap. 527 Family Status Discrimination Ordinance. Hong Kong Retrieved from https://www.elegislation.gov.hk/hk/cap527.

There is no dementia-specific or universal legislation pertaining to protect the rights of family and other unpaid carers in Hong Kong. The Employment Ordinance (Cap. 57) is the main piece of legislation governing conditions of employment in Hong Kong, which does not apply to domestic helpers, carers, or other personal helpers who dwell free of charge in their employing household (Department of Justice, 2019a).

References:

Department of Justice. (2019a). Cap. 57 Employment Ordinance. Hong Kong: Department of Justice, HKSAR Retrieved from https://www.elegislation.gov.hk/hk/cap57.

There is no dementia-specific or universal legislation and policy pertaining to place the caregiving responsibility of older parents directly on their off-spring in Hong Kong. The filial responsibility law was proposed by the Provisional Legislative Council in 1998, but it was voted down due to the lack of support from older parents who were concerned about affecting family harmony (Ting et al., 2009). There is controversy on enacting filial support legislation to share the burden of care for older dependent people between the Government and their adult children. Currently, a person would have salary tax deduction through Dependent Parent and Dependent Grandparent Allowance and Elderly Residential Care Expenses for giving support to a parent or grandparent (Inland Revenue Department, 2020, February). Although the process of industrialisation and urbanisation might decrease the availability of family care, family members are still the major care providers for older people in Hong Kong (Sum et al., 2001).

References:

Inland Revenue Department. (2020, February). Salaries Tax / Personal Assessment.  Retrieved from https://www.ird.gov.hk/eng/pdf/pam61e.pdf.

Sum, Y., Chou, K.-l. J. A. P. J. o. S. W., & Development. (2001). Filial support legislation in Hong Kong: A sensible and practical policy? , 11(1), 131-140. https://doi.org/10.1080/21650993.2001.9755852

Ting, G., Woo, J., To, C., Woo, J. J. A. J. o. G., & Geriatrics. (2009). Elder care: is legislation of family responsibility the solution. 4(2), 72-75. Retrieved from https://hkag.org/Publications/AJGG/V4N2/OA2009-62.pdf

Two legal procedures are in place pertaining to protect the property and affairs for mentally incapacitated persons and their carers. According to the Enduring Powers of Attorney Ordinance (Cap. 501), a “committee” normally be a relative, professional, or official solicitor can be appointed through the court when an older person suffering from dementia cannot manage his or her financial affairs. According to the Mental Health Ordinance (Cap. 136), an application by a relative, social worker, or medical practitioner must be made to the guardianship board to deal with the welfare and physical care for mentally incapacitated persons. The guardian has significant power over the mentally incapacitated individuals, including their residence, medical and dental treatments (Ko, 2019, March 26).

References:

Ko, B. (2019, March 26). Ageing Hong Kong needs better laws to protect the elderly and dementia sufferers. South China Morning Post. Retrieved from https://www.scmp.com/comment/letters/article/3003142/hong-kongs-population-ages-it-needs-better-laws-protect-dementia

Currently, a guideline provides common references to primary health care professionals working for preventive care for older people in Hong Kong. Dementia is covered in “Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment” (Department of Health, 2017c).

References:

Department of Health. (2017c). Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment.  Retrieved from https://www.fhb.gov.hk/pho/english/resource/files/Module_on_Cognitive_Impairment.pdf.

This reference framework is a national guideline developed by the Government, more specifically, by the Department of Health (DH).

This reference framework is approved by the Government and provided by the Primary Healthcare Office of the Food and Health Bureau (FHB).

Two chapters in the guideline cover the risk reduction and prevention of dementia (Chapter 1.3 & Chapter 4.4). The modifiable and non-modifiable risk factors identified for cognitive impairment include the followings (Department of Health, 2017b, p. 9):

Modifiable risk factors

Lifestyle

• Smoking
• Alcohol
• Physical inactivity
• Low participation of cognitive activities
• Social isolation

Vascular risk

• Hypertension
• Diabetes mellitus
• Overweight & obesity
• Stroke

Others

• Depression
• Drugs
• Low education attainment
• Head injury

Non-modifiable risk factors

• Advancing age
• Family history
• Genetics
• Gender

For the prevention of cognitive impairment, some advices are provided on enhancing cognitive reserve and reducing modifiable risks of dementia. They include stop smoking, healthy eating, stay physically and socially active, participate in intellectual and leisure activities, prevent head injury, avoid excessive alcohol use, maintain optimal levels of health indicators (e.g., body weight, waistline, blood pressure, blood sugar and blood cholesterol), and collaborate with care providers on the management of other medical conditions (e.g., heart diseases, stroke, and depression). Besides, the guideline recommends that avoiding the long-term use of hypnotics, practicing Tai Chi, early detection of cognitive impairment, and seeking medical advice are important to prevent cognitive impairment (Department of Health, 2017b, p. 32).

References:

Department of Health. (2017b). Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment. Retrieved from https://www.fhb.gov.hk/pho/rfs/english/pdf_viewer.html?file=download215&title=string258&titletext=string189&htmltext=string189&resources=07_Module_on_Cognitive_Impairment

According to the guideline, dementia is a progressive and mostly irreversible cognitive decline that causes functional impairment in daily activities. There are four major subtypes of dementia, which are Alzheimer’s disease (AD), vascular dementia (VaD), mixed dementia, and other subtypes such as dementia with Lewy bodies (DLB), frontotemporal dementia (FTD) and Parkinson’s disease dementia (PDD) (Department of Health, 2017b). One chapter in the guideline covers the diagnosis of dementia (Chapter 3). The assessment of cognitive impairment in primary care setting should include history, physical examination, cognitive screening test, appropriate investigations, and review of medications which may adversely affect the cognitive functions of the elderly people (Department of Health, 2017b). An algorithm for the assessment of cognitive impairment in older people in primary care setting can be found on page 13 of the guideline (Department of Health, 2017b, p.13).

References:

Department of Health. (2017b). Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment. Retrieved from https://www.fhb.gov.hk/pho/rfs/english/pdf_viewer.html?file=download215&title=string258&titletext=string189&htmltext=string189&resources=07_Module_on_Cognitive_Impairment

One chapter in the guideline covers the management of dementia (Chapter 4). Management of cognitive impairment in primary care setting requires a multi-disciplinary team approach to achieve the goals on improving quality of life, maximising functional performance, and addressing mood and behaviour of the older person. The algorithm for management of cognitive impairment in older people in primary care setting can be found at page 22 of the guideline (Department of Health, 2017b, p.22)

References:

Department of Health. (2017b). Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment. Retrieved from https://www.fhb.gov.hk/pho/rfs/english/pdf_viewer.html?file=download215&title=string258&titletext=string189&htmltext=string189&resources=07_Module_on_Cognitive_Impairment.

One chapter in the guideline covers the post-diagnostic supports for people with dementia and their family carers (Chapter 5). Primary care providers should provide individualised management plan to address the changing needs at different stages of dementia, which usually follow a slow deterioration and a functional dependency along the journey of dementia care from diagnosis to end-of-life (Department of Health, 2017b, p. 33).

References:

Department of Health. (2017b). Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment. Retrieved from https://www.fhb.gov.hk/pho/rfs/english/pdf_viewer.html?file=download215&title=string258&titletext=string189&htmltext=string189&resources=07_Module_on_Cognitive_Impairment

The chapter of information and advice provision (Chapter 4.2.5) mentions the importance of long-term care and advanced care planning at an earlier stage. Clinicians should explain the legal provision and discuss with persons with dementia and their families for medical, financial, and legal decision making. For advance care directives and enduring powers of attorney, it should be made when the older person is mentally capable. For guardianship order, it should be used to promote the interests of the mental incapacitated person who can only grant limited powers to a guardian (Department of Health, 2017b, p. 26).

References:

Department of Health. (2017b). Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment. Retrieved from https://www.fhb.gov.hk/pho/rfs/english/pdf_viewer.html?file=download215&title=string258&titletext=string189&htmltext=string189&resources=07_Module_on_Cognitive_Impairment

The chapter regarding specialist referral (Chapter 4.2.7) mentions the need of palliative and end-of-life care to address the complicated care needs at an advanced stage of dementia (Department of Health, 2017b, p. 28). The chapter of dementia care journey (Chapter 5) suggests some possible interventions at the end-of-life stage. For individuals with dementia, primary care providers should liaise with secondary care providers to provide palliative care and follow the advanced care plan if any. For caregivers and families, primary care providers should provide education, bereavement support, follow up on mood problems, and referral to support group when needed (Department of Health, 2017b, p. 34).

References:

Department of Health. (2017b). Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment. Retrieved from https://www.fhb.gov.hk/pho/rfs/english/pdf_viewer.html?file=download215&title=string258&titletext=string189&htmltext=string189&resources=07_Module_on_Cognitive_Impairment

The care in nursing and residential care facilities is not clearly mentioned in the guideline. The chapter of behavioural and psychological management (Chapter 4.3.2) mentions that the leading cause for assisted living in nursing and residential care homes is mainly related to the caregiving stress on behavioural and psychological symptoms of dementia (BPSD) (Department of Health, 2017b, p. 30). The close monitoring by health professionals in nursing and residential care homes can reduce the continuous use of antipsychotics for BPSD (Department of Health, 2017b, p. 32).

References:

Department of Health. (2017b). Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment. Retrieved from https://www.fhb.gov.hk/pho/rfs/english/pdf_viewer.html?file=download215&title=string258&titletext=string189&htmltext=string189&resources=07_Module_on_Cognitive_Impairment

The care in hospitals is not clearly mentioned in the guideline. However, the chapter regarding progressive cognitive symptoms management (Chapter 4.3.1) mentions the provision of structured activity training at public hospitals and community centres for individuals with dementia. They include daily use of memory aids, cognitive stimulation games, lifestyle readjustment, body-mind interaction activities, breathing and muscle relaxation exercises, and the use of online self-help resources. Timely referral to health professionals should be made according to the progress of cognitive decline of persons with dementia, especially for those requiring medical attention (Department of Health, 2017b, p. 29).

References:

Department of Health. (2017b). Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment. Retrieved from https://www.fhb.gov.hk/pho/rfs/english/pdf_viewer.html?file=download215&title=string258&titletext=string189&htmltext=string189&resources=07_Module_on_Cognitive_Impairment

This guideline was developed by the Department of Health (DH) in 2017, with the support of the Advisory Group on Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings, Hong Kong College of Psychiatrists, Hong Kong Geriatrics Society, and Hospital Authority (HA) (Department of Health, 2017b, p. 1).

References:

Department of Health. (2017b). Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment. Retrieved from https://www.fhb.gov.hk/pho/rfs/english/pdf_viewer.html?file=download215&title=string258&titletext=string189&htmltext=string189&resources=07_Module_on_Cognitive_Impairment

There is no clear content about the expectations of different stakeholders in relation to the guideline.

Yes, the chapter regarding progressive cognitive symptoms management (Chapter 4.3.1) mentions the pharmacological treatments for symptomaitc relief in dementia especially for Alzheimer’s disease. They include Cholinesterase inhibitor (ChEI) (e.g., Donepezil, Rivastigmine, Galantamine) and N-methyl-D-aspartate (NMDA) receptor antagonist (e.g., Memantine) (Department of Health, 2017b, pp. 29-30). These medicines are included in the Hospital Authority Drug Formulary in Hong Kong (The Government of the Hong Kong SAR, 2015, February 25).

References:

Department of Health. (2017b). Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment. Retrieved from https://www.fhb.gov.hk/pho/rfs/english/pdf_viewer.html?file=download215&title=string258&titletext=string189&htmltext=string189&resources=07_Module_on_Cognitive_Impairment

The Government of the Hong Kong SAR. (2015, February 25). LCQ17: Dementia [Press release]. Retrieved from https://www.info.gov.hk/gia/general/201502/25/P201502250512.htm

Along with the cognitive function declines and the increase of behavioural and psychological symptoms, primary care providers should make referral to specialists (e.g., geriatricians, psychiatrists, neurologists) for specific pharmacological treatments when necessary. Pharmacological treatments should be used with caution while considering the expectations of patients and families, possible side effects, and other health problems that can be incurred by patients (Department of Health, 2017b, p. 29).

References:

Department of Health. (2017b). Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment. Retrieved from https://www.fhb.gov.hk/pho/rfs/english/pdf_viewer.html?file=download215&title=string258&titletext=string189&htmltext=string189&resources=07_Module_on_Cognitive_Impairment

The Government adopts a multi-disciplinary and cross-sectoral approach in the provision of dementia care services. The Mental Health Review Report (MHRR) presents integrated service components within the existing care for persons with dementia. A table summarising these components can be found in p.174 of the report (Food and Health Bureau, 2017a, p. 174).

Besides, it proposes a medical-social collaboration model to deliver care services along to the continuum of care at different stage of dementia in a more cost-effective and sustainable way. The model can be found at p.181 of the report (Food and Health Bureau, 2017a, p. 181).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

The health sector is included in the coordinated planning and resourcing across the continuum of dementia care. It involves the Food and Health Bureau (FHB), Hospital Authority (HA), and Department of Health (DH) to provide public health services to people with dementia.

The social sector is included in the coordinated planning and resourcing across the continuum of dementia care. It involves the Labour and Welfare Bureau (LWB) and Social Welfare Department (SWD) to provide community, residential, and long-term care services to people with dementia.

Education sector is included in the planning of school curriculum, training programs for health and social care professionals, and conducting research on dementia. It involves the Education Bureau (EDB), Hospital Authority (HA), Department of Health (DH), and Social Welfare Department (SWD), as well as the collaborations between various NGOs, academic, and research institutions.

Employment sector is not clearly included in the coordinated planning and resourcing across the continuum of dementia care. The Labour Department (LD), Food and Health Bureau (FHB), and Labour and Welfare Bureau (LWB) are responsible for the employment issue and regulation of care professions in Hong Kong.

The justice sector is included in the legal protection of people with dementia relating to advance care directives, power of attorney, and guardianship. The Department of Justice (DoJ) and Legislative Council are responsible for legislation in Hong Kong.

The housing sector is included in developing a dementia friendly housing community and providing home modification services to people with dementia. It involves the Housing Department (HD) and Hong Kong Housing Society (HKHS), as well as collaborations between Hospital Authority (HA), Department of Health (DH), and Social Welfare Department (SWD) to deal with housing-related matters and provide home-based support to people with dementia.

The civil society sector is included in the coordinated planning and resourcing across the continuum of dementia care. Various NGOs are involved in providing public prevention, post-diagnostic support, community and residential care services, and palliative care to people with dementia.

The transport sector is not clearly included in the coordinated planning and resourcing across the continuum of dementia care. It may be involved in some public education and dementia friendly community projects. The Transport and Housing Bureau (THB), Transport Department (TD) and public transport service operators are involved in transport-related matters in Hong Kong.

The private sector is included in the coordinated planning and resourcing across the continuum of dementia care. It involves private service providers which deliver a variety of health and social care to people with dementia, such as pre-diagnosis, diagnosis, post-diagnosis, primary, secondary, and specialist care.

Apart from the sectors mentioned above, the Hong Kong Police Force provide missing persons support services to people with dementia and their families.

The coordinated planning and resourcing of care for people with dementia is implemented at the national level in Hong Kong.

Formal agreements and joint plans exist and take place across sectors within the government for people with dementia. For example, the Government has launched the Dementia Community Support Scheme in 2017 to provide multi-disciplinary community support services through medical-social collaboration for persons with mild or moderate dementia and family carers. This scheme was steered by the Food and Health Bureau (FHB) in collaboration with Social Welfare Department (SWD) and Hospital Authority (HA) (Food and Health Bureau, 2017a, p. 25).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

The Government adopts a multidisciplinary and interdisciplinary approach in providing holistic care to people with dementia and their family carers. It consists of different sectors, disciplines, and members working together interdependently in the coordinated planning and resourcing across the continuum of dementia care.

Task shifting or sharing is not clearly mentioned in the components of care coordination in the existing dementia care model. In terms of workforce shortage in health and social care settings, task-shifting or sharing may happen among care professionals. Besides, the District Elderly Community Centre (DECC) may act as a sharing of burden on community support services to older people including dementia at district level and early screening of dementia at primary level.

The “Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment” provides referral protocols or pathways that outline responsibilities of different departments and health professionals involved.

Continuity of information is one of the identified areas for service improvement in the existing dementia care model. An integrated database and information system for delivering long-term care for people with dementia is recommended in the Elderly Services Programme Plan (ESPP).

Provider continuity is one of the identified areas for service improvement in the existing dementia care model. A case management model for establishing a therapeutic relationship and better coordination among different services is recommended in the Elderly Services Programme Plan (ESPP).

The Government adopts a community-based approach in the provision of care to achieve the goal of age in place for people with dementia. The Mental Health Review Report (MHRR) and Elderly Services Programme Plan (ESPP) identify some areas for community-based service improvement and make recommendations.

Not applicable.

The care coordination between multiple governmental sectors is occurring across primary, secondary, and tertiary levels for people with dementia and their family carers is described in section 04.07.01. The Mental Health Review Report (MHRR) illustrates a care pyramid in addressing appropriate levels of care and multiple needs at different stages of dementia (Food and Health Bureau, 2017a, p. 184).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

The Government promotes a coordinated cross-sectoral and multi-disciplinary approach for dementia care. Health professionals and care workers are trained by academic institutions to provide quality care regulated by the government sectors, as well as the collaborations with NGOs and other sectors. The Dementia Community Support Scheme shows an example of care coordination between Social Welfare Department (SWD), Hospital Authority (HA), and NGOs, which work together to organise and provide community support services to persons with mild or moderate dementia and their family carers. The supervisory roles and corresponding responsibilities of these parties are listed below (Food and Health Bureau, 2017a, pp. 25-26):

Social Welfare Department (SWD)

• Supervisory role of care coordination;
• Referral of persons with suspected indicators on early dementia in the community.

Hospital Authority (HA)

• Referral of suitable patients with mild or moderate dementia;
• Primary care doctors (e.g., general practitioners) to provide medical support to stable patients through public-private partnership.

NGOs

• 20 subvented District Elderly Community Centre (DECC);
• Health & social professionals provide support to persons with dementia participating DECC.

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

With the concerns on long waiting times and inadequate provision of health and social care services for persons with dementia, some stakeholders have recommended the Government to strengthen the existing dementia care service model and develop dementia-specific policy in Hong Kong. They suggest putting more efforts on public education to raise awareness and reduce stigma, health assessment and early diagnosis in primary care setting, long-term care and intervention to achieve age in place, and carers training to reduce caregiving burden (Legislative Council Secretariat, 2017, February 21).

References:

Legislative Council Secretariat. (2017, February 21). Care services for elderly persons with dementia. Retrieved from https://www.legco.gov.hk/research-publications/english/essentials-1617ise10-care-services-for-elderly-persons-with-dementia.htm

As mentioned in previous sections, the Government has been reviewing existing strategies on dementia care, budget allocation, and workforce enhancement. Indeed, it has implemented the Dementia Community Support Scheme in 2017. Also, the Social Welfare Department (SWD) has been coordinating with relevant departments to reserve sites for the provision of more day care and residential care units for older people. Besides, the Government is pledged to continue the public consultation on advanced care directives which is a major concern on the end-of-life care for older people including dementia. Based on the Mental Health Review Report (MHRR) and the Elderly Services Programme Plan (ESPP), it is expected that the Government will continue to serve as a platform facilitating coordination among bureaus, departments and organisations, and regularly review the progress of change in relevant policies and financing for dementia in the future. However, no clear information or specific evidence could be found at the time of this desk review (March 2020).

Not applicable, there is no clear information or specific evidence could be found at the time of this desk review (March 2020).

Not applicable for questions from 04.08.04.01 to 04.08.04.03, as there is no clear information or specific evidence could be found at the time of this desk review (March 2020).

Not applicable for questions from 04.08.04.01 to 04.08.04.03, as there is no clear information or specific evidence could be found at the time of this desk review (March 2020).

Not applicable for questions from 04.08.04.01 to 04.08.04.03, as there is no clear information or specific evidence could be found at the time of this desk review (March 2020).

Not applicable, there is no clear information or no specific evidence could be found at the time of this desk review (March 2020).

A wide range of stakeholders can be involved in generating a policy change in relation to dementia in Hong Kong. They include persons with dementia, family carers, social and health service providers, academics, philanthropists, policy advisors, government officers, and as well as the general public.

2018 – 2021

A three-year public education programme named “Dementia Friendly Community Campaign” has been launched by the Social Welfare Department of the Government in Hong Kong in September 2018. The aim of the campaign is to advocate public awareness and understanding of dementia and the building of a dementia-friendly community for individuals with dementia and their families (Social Welfare Department, 2019, August 28). The campaign comprises of different activities, including a set of announcements in public television and radio, a designated webpage (https://www.swd.gov.hk/dementiacampaign/en/index.html), an 8-epsiodes television docudrama and radio content on dementia, dementia-related movie screening and sharing, district programmes on public education, cognitive stimulation, carer support activities, as well as information sessions on Dementia Friends and workshops on Dementia Friends Ambassadors.

2018 – 2021

“Dementia-Friendly Community in Southern District” is a district-based campaign, funded by the Community Investment and Inclusion Fund of the Government and implemented by the NGO Christian Family Service Centre, in the Southern District, which is one of the 18 districts in Hong Kong. This campaign aims at establishing a collaborative platform as well as a dementia-friendly community care among various organisations, business, residents, and carers within the district. Its main activities include volunteers training, registration of recognised dementia-friendly business, and free dementia screening service and home safety assessment for older adults (Christian Family Service Centre, 2020).

References:

Christian Family Service Centre. (2020). Dementia-Friendly Community in Southern District. Retrieved from https://www.cfsc.org.hk/en/whatsNew/detail/1169

Social Welfare Department. (2019 August 28). Dementia Friendly Community Campaign. Retrieved from https://www.swd.gov.hk/dementiacampaign/en/index.html

Other than the campaigns mentioned above, we conducted a search to identify all the local public awareness campaigns for dementia with the information available online. These campaigns are funded and implemented by a wide range of charitable institutions and NOGs. Details of these campaigns are summarised below (in chronological order):

2007 – ongoing

The “Love-your-brain” website (www.loveyourbrain.org.hk), funded by the charity ‘The Community Chest’ and developed by the NGO ‘The Hong Kong Society for the Aged’, was launched in 2007 as the first brain health website for the Chinese population worldwide. The website serves as a ‘brain fitness gym’ which offers different brain stimulating games which are tailored for the needs of Chinese older adults. In addition, it is also an online information hub to increase the understanding and awareness of the general public regarding the onset of dementia and ways to promote brain health.

2011 – 2012

“Active Prevention and Early Detection of Cognitive Impairment” project, funded by the charity Simon K. Y. Lee Foundation and implemented by academia and local NGOs, has launched a territory-wide education campaign from 2011 to 2012 to communicate to the public about dementia. It aimed to raise the community’s awareness on dementia and to promote the message of early detection and intervention through various channels, including talks, street exhibitions, carer training, counselling, and volunteer training, TV infotainment, newspaper columns, and radio programmes (Simon K. Y. Lee Foundation).

2012 – 2013

The “Brain Health Public Education Campaign”, funded by the Hong Kong Jockey Club Charities Trust and implemented by the Jockey Club Centre for Positive Ageing (JCCPA) and CADENZA: A Jockey Club Initiative for Seniors, is a territory-wide campaign on public brain health promotion running from September 2012 to May 2013. The campaign promoted healthy lifestyle for dementia prevention and alleviating the impact of cognitive impairment. The educational messages were disseminated through talks, game design workshops, competition, and a one-day community carnival. In addition, educational leaflets and books were distributed to primary and secondary school student and a promotion video was broadcasted through public channels (The Hong Kong Jockey Club, 2012 August 28).

2013 – ongoing

The “Jockey Club Charles Kao Brain Health Mobile Services” is a brain health promotional vehicle funded by the charities ‘The Hong Kong Jockey Club Charities Trust’ and the ‘Charles K. Kao Foundation for Alzheimer’s Disease’ and are operated by the NGO St. James’ Settlement since 2013. This vehicle has been providing territory-wide public education programmes to raise the awareness of the general public about dementia through exhibitions, talks, and promotional videos. Furthermore, it also provides preliminary assessments for older adults at risk, medical referral, and supports to persons with dementia patients and carers (St. James Settlements’, 2020).

2013 – ongoing

“Brain Health Education Programme”, launched by the Charles K. Kao Foundation in partnership with Hong Kong Alzheimer’s Disease Association, Hong Kong Repertory Theatre and Fantasy Puppet Theatre and sponsored by Shun Hing Education and Charity Fund and Providence Foundation Limited, is an ongoing project consisting of multiple series of brain health education programmes since 2013. Its delivery channels include educational talks, game booths in primary and secondary schools and distribution of educational kits to teachers (1^st series; 2013 -2014), interactive dramas for performance tour in secondary schools (2^nd series; 2013 – 2017), puppet shows for primary schools (3^rd series; 2013 – 2020), and, more recently, ethnography drama workshop and showcase performance which encourage students to study the lives of person with dementia and then showcase their learnings in the format of drama to their fellow students (Charles K Kao Foundation for Alzheimer’s Disease).

2014 – 2018

The “Dementia Concern Campaign” and “Jockey Club Dementia Friendly Communities Campaign”, a 16-month and a 2-year territory-wide campaigns funded by The Hong Kong Jockey Club Charities Trust and implemented by the Jockey Club Centre for Positive Ageing in 2014 and 2016 respectively, aimed at promoting positive attitude and acceptance towards individuals with dementia among the public, particularly amongst frontline staffs. Through talks, interactive workshops, tailor-made education, and training programmes, the campaign encouraged frontline staffs (such as security guards, drivers, and bank tellers) in different fields who would come across the elderly in their work to co-create a dementia-friendly community by providing appropriate support and assistance to persons with dementia in their workplaces and neighbourhood (Jockey Club Centre for Positive Ageing, 2018; The Hong Kong Jockey Club, 2014).

2015 – 2018

“Project Sunrise” is a district-based campaign in Tsuen Wan and Kwun Tong, which are two of the 18 districts of Hong Kong, funded by the charitable foundation Lee Hysan Foundation from 2015 to 2018. Implemented by the Hong Kong Alzheimer’s Disease Association and the Christian Family Service Centre, the project emphasized on education and early detection across different target audiences, including the general public, employees among different service industries, and general practitioners via public talks, staff trainings and workshops, educational cue cards to raise awareness and increase early detection of dementia symptoms in the community.

References:

Charles K Kao Foundation for Alzheimer’s Disease. Our Projects. Retrieved from https://www.charleskaofoundation.org/service/project

Jockey Club Centre for Positive Ageing. (2018 ). Dementia Friendly Communities.

Simon K. Y. Lee Foundation. Active Prevention & Early Detection of Cognitive Impairment (“APEC”).

St. James Settlements’. (2020). Jockey Club Charles Kao Brain Health Mobile Services. Retrieved from https://dementia.sjs.org.hk/sjs/tc/car.php?m=10&id=133

The Hong Kong Jockey Club. (2012 August 28). Jockey Club Centre for Positive Ageing advocates brain-healthy lifestyle.

The Hong Kong Jockey Club. (2014). Jockey Club supports “Dementia Concern” campaign [Press release].

Dementia training and education is currently not mandatorily covered in the formal training of the other sectors. Yet, various NGOs and academic institutions are actively promoting training programmes to other sectors to build a more dementia-friendly environment in Hong Kong. For instance, under the initiative of Dementia Friends Hong Kong (https://www.dementiafriends.hk/en/), the Hong Kong Alzheimer’s Disease Association tailored the dementia training content in terms of level of depth and scenarios for different target groups in order to equip the workforce from other sectors with knowledge about dementia and skills to communicate with individuals with dementia. Any companies or organisations that are interested in this initiative can register as a Supporting Partner of Dementia Friends Hong Kong and attend an information session to understand more about dementia.

Most of the elderly community care service units, such as the District Elderly Community Centre and the Neighbourhood Elderly Centre, have been providing volunteer training. Dementia is a common topic covered in their regular volunteer training to increase the public awareness about dementia and to equip volunteers with the skills for home visits, simple home making, and escort for medical appointments for persons with dementia.

The Hong Kong Police Force is registered as a dementia friendly organisation and has attended training workshops on dementia.  The trainings include information on dementia symptoms, communication skills, techniques to handle persons with dementia and ways to help missing individuals affected by dementia.  There is also a set of guidelines to help the Hong Kong Police to communicate with the mentally incapacitated people, which also cover the people with dementia (The Hong Kong Police Force, 2020). (Also see: https://www.police.gov.hk/offbeat/1044/eng/2939.html).

For the fire service department, there are no information indicating that it has received education or training on dementia.

References:

The Hong Kong Police Force. (2020). Mentally Incapacitated Person (MIP) New Package Retrieved from https://www.police.gov.hk/mip/en/index.html

Paramedics under Auxiliary Medical Service have received training on dementia. However, details of the training cannot be found.

Individuals with dementia are under the umbrella term of mentally incapacitated persons in the Mental Health Ordinance in Hong Kong. Through formal law education, it is believed that legal professionals in Hong Kong are equipped with knowledge on the legal procedures for defining mentally incapacitated persons. Yet, such training and education are not specifically about dementia.

Only a few companies/organisations of public services have provided dementia training to their staffs. For the public transport, the Mass Transit Railway have arranged four batches of staffs to attend the ‘Get to Know Dementia’ Training Course during 2018 – 2019 which was delivered by the Hong Kong Medical Association (http://www.hkma.org/communityhealthacademy/06.htm,

http://www.hkma.org/communityhealthacademy/04_01.htm).

For the public utility, the Hong Kong Electric Company have registered as a dementia-friendly organisation under Dementia Friends Hong Kong and have arranged talks about dementia for its staffs.

For the public housing staffs, the Hong Kong Medical Association has also provided five batches of the “Get to Know Dementia’ training course to security personnel in several public housing estates in the Eastern District in 2017 (http://www.hkma.org/communityhealthacademy/01.htm).

Although it is not part of the formal school curriculum, many primary and secondary school children have received education on dementia through educational talks, interactive drama performances, puppet shows, and drama workshops under the “Brain Health Education Programme” launched by the Charles K. Kao Foundation (Charles K Kao Foundation for Alzheimer’s Disease).

References:

Charles K Kao Foundation for Alzheimer’s Disease. Our Projects. Retrieved from https://www.charleskaofoundation.org/service/project

HSBC, one of the largest banks providing local retail banking service, is the first bank which has registered as Dementia Friends in Hong Kong. With the help from the Hong Kong Alzheimer’s Disease Association, the bank had trained and deployed dementia specialist staffs, namely Dementia Friends Ambassadors, into their branches to support persons with dementias and their carers in daily financial matters (https://www.about.hsbc.com.hk/-/media/hong-kong/en/news-and-media/190516-basic-banking-account-eng.pdf). Other than HSBC, there is no information showing that other banks have similar initiatives which provide staff training on dementia.

Some retail businesses also have registered as Dementia Friends in Hong Kong, including PARKnSHOP, a supermarket chain, Watsons, a health and beauty retail chain store, and Fortress, a major retailer of electronics and home appliances. Furthermore, the Fairwood, one of the local fast food restaurant chains, has invited the Hong Kong Medical Association to deliver two batches of dementia training to its frontline staffs (http://www.hkma.org/communityhealthacademy/06.htm).

Previous local studies showed that the negative image of dementia and the burden of taking care of a person with dementia were factors that stood in ways of Chinese older adults with early dementia from seeking the help of medical doctors (Chan, 2012). An additional local study also found that stigmatising attitudes were functioning as barriers to help-seeking (Cheng et al., 2011).

For dementia care, most nurses and personal care workers working in long-term care found it challenging; nevertheless, they had a positive attitude towards further training on dementia and they demonstrated commitment to dementia care (Lee et al., 2012).

Surveys on how the general public and primary care physicians perceive dementia diagnosis and intervention, suggest that both groups have similar perception. A recent study has shown a tolerant and proactive attitude towards early diagnosis of dementia in order to seek prompt interventions and support among most Chinese in Hong Kong (Lam et al., 2019). In the same study, practical issues and legal concerns were reported as the most and least fearful consequences associated with dementia, respectively. Most respondents were able to identify cognitive impairments as symptoms of dementia; however, there was inadequate knowledge that behavioural disturbance could be one of the possible signs of dementia as well. On the other hand, primary care physicians, in light of the additional benefits of early treatments to individuals with dementia and carers, have also shown a positive attitude towards early detection and diagnosis of dementia (Leung et al., 2020).

References:

Chan, C. K. L. (2012). A study on the help-seeking experience of Chinese older adults with early dementia in Hong Kong. The Hong Kong Polytechnic University, Retrieved from https://theses.lib.polyu.edu.hk/handle/200/7623

Cheng, S., Lam, L., Chan, L., Law, A., Fung, A., et al. (2011). The effects of exposure to scenarios about dementia on stigma and attitudes toward dementia care in a Chinese community. International Psychogeriatrics(23(9)), 1433-1441. https://doi.org/10.1017/S1041610211000834

Lam, T. P., Sun, K. S., Chan, H. Y., Lau, C. S., Lam, K. F., & Sanson-Fisher, R. (2019). Perceptions of Chinese Towards Dementia in Hong Kong-Diagnosis, Symptoms and Impacts. International journal of environmental research and public health, 16(1), 128. https://doi.org/10.3390/ijerph16010128

Lee, J., Hui, E., Kng, C., & Auyeung, T. (2012). Attitudes of long-term care staff toward dementia and their related factors. International Psychogeriatrics, 25(1), 140-147. https://doi.org/10.1017/S1041610212001512

Leung, C. W., Lam, T. P., Wong, K. W., & Chao, V. K. D. (2020). Early detection of dementia: The knowledge and attitudes of primary care physicians in Hong Kong. Dementia (London), 19(3), 830-846. https://doi.org/10.1177/1471301218788133

The Jockey Club Centre for Positive Ageing conducted a public survey in 2005 and 2015 (Jockey Club Centre for Positive Ageing, 2015) to examine the change in knowledge about dementia in Hong Kong. The comparison showed that there was a changing perception of dementia, including improvement in knowledge and awareness towards dementia and a reduction in misconception. The findings also indicate that respondents paid more attention to the signs of early dementia and became more willing to bring their family to consult with physicians when dementia symptoms emerged.

This change in public perception could be attributed to multiple factors. First, in 2010, a working group comprised of ten medical professional bodies and other dementia campaigns had suggested to change the Chinese terminology of dementia in order to alter the way people perceive individuals with dementia. The original Chinese terminology of dementia was equivalent to ‘insanity’ and ‘idiocy’, in other words, a degrading name. In fact, the medical professionals believed that the negative connotation of the Chinese terminology largely contributed to the stigmatising attitudes towards dementia, which resulted in the delay of medical consultations and in the general public’s refusal to accept diagnosis (Working Group on New Chinese Terminology for Dementia and Cognitive Impairment, 2011). In 2012, the new name which signifies dementia as a cognitive disorder, was proposed by the working group to substitute the previous demeaning name, which attempted to reduce its stigmatising connotations (Chiu & Li, 2012). The new Chinese terminology of dementia was found to be more acceptable and the vast majority (87%) supported the substitution of old term (Chiu et al., 2014). The new Chinese name of dementia is widely adopted by the media, medical professionals, general public, and the Government.

Furthermore, Professor Charles K Kao, former Professor in the Chinese University of Hong Kong and Nobel Laureate in Physics in 2009, who was known as the “Father of Fibre Optics”, battled against Alzheimer’s disease since 2002. This significantly raised the public awareness about dementia and led the public to stop viewing dementia as a taboo. In addition, Charles K Kao and his spouse founded a foundation in 2010, namely The Charles K Kao Foundation, to raise public awareness of dementia and disseminate tips on caring the brain. In addition, there were local movies surrounding dementia (such as Happiness in 2016, The Tail Before in 2018) as well as television dramas (Forensic Heroes IV, Lo and Behold) that arouse the awareness of the disease, and enhanced understanding on individuals with dementia and care needs. Aside from this, a few celebrities also shared their stories and experiences about taking care of their family members who were diagnosed with dementia (such as Kara Wai Ying-Hung, Nina Paw Hee-Ching, and Kearen Pang).

Lastly, various dementia awareness campaigns conducted by different sectors and organisations targeting different audience groups in the past decade which included students, frontline workers, and caregivers, have deepened public understanding of dementia and influenced the way they perceive dementia.

References:

Chiu, F. K., & Li, S. W. (2012). Recent Developments in Dementia: From New Diagnostic Criteria to a New Name [Editorial]. East Asian Arch Psychiatry, 22, 139-140.

Chiu, H., Sato, M., Kua, E., Lee, M., Yu, X., et al. (2014). Renaming dementia – an East Asian perspective. International Psychogeriatrics, 26, 885-887. https://doi.org/10.1017/S1041610214000453

Jockey Club Centre for Positive Ageing. (2015). Misconceptons about dementia 2015 – Factsheet for Press (v2 20150915) [Press release].

Working Group on New Chinese Terminology for Dementia and Cognitive Impairment. (2011). A new Chinese terminology for dementia and cognitive impairment. Hong Kong Med J, 17(4), 342.

Findings from a local study indicate that a brief exposure of dementia information can lead to stigma reduction and it suggests that community education is highly significant in reducing barriers towards early detection and treatment of dementia (Cheng et al., 2011). On the other hand, the renaming of Chinese terminology of dementia in 2012 also alters the way people in Hong Kong perceive dementia. A survey of 466 respondents with dementia and carers reveals that for half of them, the old Chinese name of dementia caused them to be stigmatised (Chiu et al., 2014).

References:

Cheng, S., Lam, L., Chan, L., Law, A., Fung, A., et al. (2011). The effects of exposure to scenarios about dementia on stigma and attitudes toward dementia care in a Chinese community. International Psychogeriatrics(23(9)), 1433-1441. https://doi.org/10.1017/S1041610211000834

Chiu, H., Sato, M., Kua, E., Lee, M., Yu, X., et al. (2014). Renaming dementia – an East Asian perspective. International Psychogeriatrics, 26, 885-887. https://doi.org/10.1017/S1041610214000453

The content of training varies across different organisers and target population. In general, training covers attitudes towards dementia, knowledge and understanding about dementia, brain health knowledge for dementia prevention, communication skills with individuals with dementia, and ways of coping with the impact of dementia with a positive attitude. For frontline staffs who might encounter persons with dementia in their workplace, such as police, banks, and restaurants, training contents and simulation activities are tailored to the needs of the organisation to equip them with the skills to handle potentially difficult situations specific to their workplace and in relation to dementia (Jockey Club Centre for Positive Ageing, 2018).

References:

Jockey Club Centre for Positive Ageing. (2018 ). Dementia Friendly Communities.

One of the major goals of the 3-year Dementia Friendly Community Campaign is to have 10,000 individuals from the general public to register as Dementia Friends Hong Kong during 2019 – 2021. As of March 2020, there have already been over 15,400 Dementia Friends in Hong Kong, which has far exceeded its targeted number (Hong Kong Alzheimer’s Disease Association, 2020a). Other than the number of registered Dementia Friends, there is no other source of evaluation or evidence of impact identified.

References:

Hong Kong Alzheimer’s Disease Association. (2020a). Dementia Friends Hong Kong. Retrieved from https://www.dementiafriends.hk/en/

In view of the rapid population ageing in Hong Kong, a 5-year charity-funded project ‘The Jockey Club Age-friendly City Project’ was launched in 2015. Partnering with four academic institutions, the project visions to evolve Hong Kong as an age-friendly city through evaluating the territory-wide age-friendliness according to the age-friendly city domains identified by the World Health Organization (World Health Organization, 2007) and suggesting a suitable framework for relevant stakeholders to follow and act upon. As the Jockey Club Age-friendly project is still ongoing, the actions derived from this project are yet to be confirmed. For details of the action plan and suggestions, please refer to its report on age-friendliness: https://www.jcafc.hk/uploads/docs/Cross-district-report-of-baseline-assessment-on-age-friendliness-(18-districts).pdf  (Jockey Club Institute of Ageing et al., 2019).

References:

Jockey Club Institute of Ageing, T. C. U. o. H. K., Sau Po Centre on Ageing, T. U. o. H. K., Asia-Pacific Institute of Ageing Studies, L. U., & Institute of Active Ageing, T. H. K. P. U. (2019). Jockey Club Age-friendly City Project Cross-district Report of Baseline Assessment on Age-friendliness (18 Districts). Retrieved from https://www.jcafc.hk/uploads/docs/Cross-district-report-of-baseline-assessment-on-age-friendliness-(18-districts).pdf

World Health Organization. (2007). Global Age-Friendly Cities: a Guide Retrieved from https://www.who.int/ageing/publications/age_friendly_cities_guide/en/

Yes. Suggestions are listed under the domain of Outdoor Spaces and Buildings in the Jockey Club Age-friendly City Project.

Yes. Suggestions are listed under the domain of Transportation in the Jockey Club Age-friendly City Project.

Yes. Suggestions are listed under the domain of Housing in the Jockey Club Age-friendly City Project

Furthermore, since 2005, the Hong Kong Housing Society has set up an Elderly Resources Centre and Age-friendly home website. The centre offers experimental tours and professional consultation services in order to suggest suitable home products and modification for the elderly, including for the individuals with dementia, and their carers (The Hong Kong Housing Society). Other than regular age-friendly product update, its website (http://www.hkhselderly.com/afh/?lang=en) also helps to evaluate the degree of age-friendliness of a home environment by completing a 20-item assessment and make suggestions based on the results.

References:

The Hong Kong Housing Society. Elderly Resources Centre & Website. Retrieved from https://www.hkhs.com/en/our-business/elderly-housing/elderly-resources-centre

Yes. The Gerontech and Innovation Expo cum Summit, an annual Gerontech fair hosted by the Government and the Hong Kong Council of Social Service, was launched since 2017. It allows companies to display their newly developed gerontech products and equipment designed to enhance the quality of life of the elderly, including individuals with dementia (The Gerontech and Innovation Expo cum Summit, 2019).

Besides, the Government has also established the Innovation and Technology Fund for Application in Elderly and Rehabilitation Care in 2018, to provide subsidy for the purchase, rental, and trial usage of innovative technology products for the elderly and rehabilitation service units. Organisations that provide community care or rehabilitation services to disabled people and/or the elderly (including persons with dementia) could apply for this funding (Social Welfare Department, 2020, February 4).

References:

Social Welfare Department. (2020, February 4). Innovation and Technology Fund for Application in Elderly and Rehabilitation Care. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_supportser/sub_itfund/

The Gerontech and Innovation Expo cum Summit. (2019). Background. Retrieved from https://gies.hk/en/site/background

Yes. Suggestions are listed under the domain of Outdoor Spaces and Buildings in the Jockey Club Age-friendly City Project.

Yes. Suggestions are listed under the domain of Social Participation and Communication and information in the Jockey Club Age-friendly City Project.

The number of people with dementia is occasionally but not routinely monitored in Hong Kong. Although there is no official annual statistics about dementia from the Government, different NGOs and research institutions have been investigating and monitoring the prevalence, needs of service, and care burden among people with dementia and their family carers (The Government of the Hong Kong SAR, 2015, June 17).

References:

The Government of the Hong Kong SAR. (2015, June 17). LCQ16: Dementia [Press release]. Retrieved from https://www.info.gov.hk/gia/general/201506/17/P201506170682.htm

Jointly conducted by the Elderly Health Service Department of Health of the Government and the Department of Psychiatry of the Chinese University of Hong Kong, the population-based study in 2005-2006 provided the most up-to-date estimates of dementia prevalence in Hong Kong (Elderly Commission, 2006).

References:

Elderly Commission. (2006). Prevalence of dementia in Hong Kong.  Retrieved from https://www.elderlycommission.gov.hk/en/download/meeting/Study%20on%20Prevalence%20of%20dementia.pdf.

The population-based study was a one-time thematic household survey to identify the prevalence of dementia, the proportion of different severity levels, and the subtypes of dementia among 6,100 people aged 60 or over living in the community (Elderly Commission, 2006).

References:

Elderly Commission. (2006). Prevalence of dementia in Hong Kong.  Retrieved from https://www.elderlycommission.gov.hk/en/download/meeting/Study%20on%20Prevalence%20of%20dementia.pdf.

The result of the estimates of dementia can be found in the website of Department of Health (Elderly Commission, 2006) and in a published article “Prevalence of very mild and mild dementia in community-dwelling older Chinese people in Hong Kong” (Lam et al., 2008).

References:

Elderly Commission. (2006). Prevalence of dementia in Hong Kong.  Retrieved from https://www.elderlycommission.gov.hk/en/download/meeting/Study%20on%20Prevalence%20of%20dementia.pdf.

Lam, L. C., Tam, C. W., Lui, V. W., Chan, W., Chan, S. S., Wong, S., . . . Chiu, H. (2008). Prevalence of very mild and mild dementia in community-dwelling older Chinese people in Hong Kong. International Psychogeriatrics, 20(1), 135-148. https://doi.org/10.1017/S1041610207006199

In the population-based study, the prevalence of dementia can be disaggregated by gender, age, severity, and subtypes of dementia.

From the population-based study conducted in 2005-2006, the prevalence of dementia in Hong Kong was 7.2% in people aged 60 and above (9.85% for female and 4.2% for male) and 9.3% in people aged 70 and above (15.3% for female and 8.9% for male). Alzheimer’s disease was the most common type of dementia which accounted for 63% of dementia patients. And 83% of the patients were in the mild stage (Elderly Commission, 2006). There is no available data for the incidence of dementia in Hong Kong.

Moreover, there are some additional sources estimating the prevalence of dementia in Hong Kong. A systematic review published in 2013, for example, estimated that the prevalence of dementia among people aged 65 and over was 6.8% in Hong Kong (Wu et al., 2013). Another study makes use of secondary data to predict the prevalence and trends of dementia in Hong Kong. It is projected that the number of people with dementia aged 60 years and above would increase from 103,433 in 2009 to 332,688 in 2039, an increase by more than 3 times (Yu et al., 2012). Besides, the population health survey in 2014-2015 estimates that the overall population prevalence of self-reported dementia is 0.6% for female and 0.2% for male (Centre for Health Protection, 2017). The Hospital Authority also estimates that 5-8% people aged 65 years and above and 20-30% people aged 80 years and above would have dementia of different extents (Hospital Authority, 2020, April 20).

References:

Centre for Health Protection. (2017). Report of Population Health Survey 2014/15. Retrieved from https://www.chp.gov.hk/en/static/51256.html

Elderly Commission. (2006). Prevalence of dementia in Hong Kong.  Retrieved from https://www.elderlycommission.gov.hk/en/download/meeting/Study%20on%20Prevalence%20of%20dementia.pdf.

Hospital Authority. (2020, April 20). Dementia. Retrieved from https://www21.ha.org.hk/smartpatient/SPW/en-US/Disease-Information/Disease/?guid=0ff3b12b-b3c0-4fa9-9bac-6bcf9dc501ba

Wu, Y.-T., Lee, H.-y., Norton, S., Chen, C., Chen, H., He, C., . . . Brayne, C. J. P. O. (2013). Prevalence studies of dementia in mainland china, Hong Kong and taiwan: a systematic review and meta-analysis. 8(6), e66252. https://doi.org/10.1371/journal.pone.0066252

Yu, R., Chau, P. H., McGhee, S. M., Cheung, W. L., Chan, K. C., Cheung, S. H., & Woo, J. (2012). Trends in prevalence and mortality of dementia in elderly Hong Kong population: projections, disease burden, and implications for long-term care. International Journal of Alzheimer’s Disease, 2012. https://doi.org/10.1155/2012/406852

As of July 2018, dementia was the 8^th and 5^th leading cause of death for males and females, respectively (Healthy HK, 2018, July 19). In 2017, a total of 1,455 people (557 males, 898 females) lost their life due to dementia, which accounted for 3.1% of the total deaths (Centre for Health Protection, 2019). Between 2001 and 2009, people aged 60 and above who died due to dementia, were doubled from 1% to 2% of all deaths. The age-standardised mortality rate (per 100,000 population) of dementia increased from 23.3 to 47.3 for males, and from 45.6 to 62.0 for females. The mortality rates increased exponentially with age (Yu et al., 2012). Between 2001 and 2010, there were 145 deaths of centenarian due to dementia (Yu et al., 2017).

The disability-adjusted life years (DALYs) lost due to dementia for people aged 60 and above was 286,313 in 2006, which included 83,051 (29%) for males and 203,262 (71%) for females. Most of the burden was due to disability, with 284,326 (99%) of years lost due to disability (YLDs) and 1,987 (1%) of years of life lost (YLLs) (Yu et al., 2012).

References:

Centre for Health Protection. (2019, January 11). Number of Deaths by Leading Causes of Death by Sex by Age in 2017. Retrieved from https://www.chp.gov.hk/en/statistics/data/10/27/340.html

Healthy HK. (2018, July 19). Leading cause of all deaths.

Yu, R., Chau, P. H., McGhee, S. M., Cheung, W. L., Chan, K. C., Cheung, S. H., & Woo, J. (2012). Trends in prevalence and mortality of dementia in elderly Hong Kong population: projections, disease burden, and implications for long-term care. International Journal of Alzheimer’s Disease, 2012. https://doi.org/10.1155/2012/406852

Yu, R., Tam, W., & Woo, J. (2017). Trend of centenarian deaths in Hong Kong between 2001 and 2010. Geriatrics & gerontology international, 17(6), 931-936. https://doi.org/10.1111/ggi.12812

The years lost due to disability (YLDs) accounted for 99% of the disability-adjusted life years (DALYs) lost due to dementia for people aged 60 and over in 2006. Male experienced 82,212 YLDs and female experienced 202,114 YLDs (Yu et al., 2012).

References:

Yu, R., Chau, P. H., McGhee, S. M., Cheung, W. L., Chan, K. C., Cheung, S. H., & Woo, J. (2012). Trends in prevalence and mortality of dementia in elderly Hong Kong population: projections, disease burden, and implications for long-term care. International Journal of Alzheimer’s Disease, 2012. https://doi.org/10.1155/2012/406852

There are no estimates of prevalence of dementia by different geographical areas in Hong Kong.

So far, two local studies have examined the age of onset of dementia in Hong Kong. According to a retrospective case notes review of 454 consecutive people with dementia and mild cognitive impairment at Princess Margaret Hospital in Hong Kong from 1999 to 2004, the average age of dementia onset was 76.7 ± 8.7. The median duration from the symptom onset to medical consultation was 2 years (range from 4 months to 10 years) with a mean of 14.8 months (Sheng, Law, & Yeung, 2009). Another earlier study found that the age of onset of Alzheimer’s disease was related to the frequency of Apolipoprotein E epsilon 4 allele (ApoE) among 65 people with dementia. The mean age of onset identified was 73.7 (Mak et al., 1996).

References:

Mak, Y., Chiu, H., Woo, J., Kay, R., Chan, Y., Hui, E., et al. (1996). Apolipoprotein E genotype and Alzheimer’s disease in Hong Kong elderly Chinese. Neurology, 46(1), 146-149. https://doi.org/10.1212/wnl.46.1.146

Sheng, B., Law, C. B., & Yeung, K. M. (2009). Characteristics and diagnostic profile of patients seeking dementia care in a memory clinic in Hong Kong. International psychogeriatrics, 21(2), 392-400. https://doi.org/10.1017/S104161020800817X

A study estimates the life expectancy among people with or without dementia using the Hong Kong Life Tables 2006-2036. In 2006, people with dementia at age 60 were expected to live for 16 years for males and 22 years for females, respectively (Yu et al., 2010).

References:

Yu, R., Chau, P. H., McGhee, S. M., Cheung, W. L., Chan, K. C., Cheung, S. H., & Woo, J. (2010). Dementia Trends: Impact of the Ageing Population and Societal Implications for Hong Kong. In. Hong Kong: The Hong Kong Jockey Club Charities Trust.

There is evidence of differences in dementia prevalence by gender. A study further estimates the difference in prevalence of very mild and mild dementia by gender for people aged 60 and over and people aged 70 and over. For mild dementia, the prevalence for female and male aged 60 and above were 7.6% and 3.1% respectively; and for female and male aged 70 or above were 12.3% and 5.0% respectively (Lam et al., 2008). However, there is no data regarding the difference in dementia prevalence on different ethnic groups in Hong Kong.

References:

Lam, L. C., Tam, C. W., Lui, V. W., Chan, W., Chan, S. S., Wong, S., . . . Chiu, H. (2008). Prevalence of very mild and mild dementia in community-dwelling older Chinese people in Hong Kong. International Psychogeriatrics, 20(1), 135-148. https://doi.org/10.1017/S1041610207006199

In 2006, a study estimated that there was a difference of 7 years of life expectancy at age 60 between people with and without dementia. The life expectancy of male and female with dementia at age 60 were 16 and 22 respectively (Yu et al., 2010).

Table 6.5. Life expectancy of general population and population with or without dementia by gender in 2006  (Yu et al., 2010).

References:

Yu, R., Chau, P. H., McGhee, S. M., Cheung, W. L., Chan, K. C., Cheung, S. H., & Woo, J. (2010). Dementia Trends: Impact of the Ageing Population and Societal Implications for Hong Kong. In. Hong Kong: The Hong Kong Jockey Club Charities Trust.

The prevalence of different severity and subtypes of dementia are reported in question 06.02.01. For HIV-dementia, a study estimates the prevalence of HIV-associated neurocognitive disorder of 98 participants from Queen Elizabeth Hospital in Hong Kong using the International HIV Dementia Scale (IHDS) and Montreal Cognitive Assessment (MoCA) from 2013 to 2015. The results show that 38 (39%) and 25 (26%) participants scored below the cut-offs of IHDS (≤10) and MoCA (25/26), respectively (Chan et al., 2019).

Another study investigates the diagnostic profiles of 436 consecutive patients with dementia and mild cognitive impairment at Princess Margaret Hospital in Hong Kong between 1999 and 2004. The distribution of dementia subtypes were: Alzheimer’s disease 49.3%, Vascular dementia 23.1%, Dementia with Lewy bodies 4.6%, Frontotemporal dementia 1.6%, Mild cognitive impairment 6.2%, Undetermined dementia 4.4%, Other irreversible dementia 5.3%, and Reversible dementia 5.5%. Reversible dementia included depression, delirium, anxiety disorder, psychosis, hyponatremia, epilepsy, Parkinson’s disease, adjustment disorder, and vitamin B12 deficiency. Other irreversible dementia included Parkinson’s disease dementia, post-concussion dementia, brain tumour, subdural effusion, alcohol dementia, Huntington’s disease, anoxic brain insult, uraemia, and subarachnoid haemorrhage (Sheng et al., 2009).

References:

Chan, F. C., Chan, P., Chan, I., Chan, A., Tang, T. H., et al,. (2019). Cognitive screening in treatment-naïve HIV-infected individuals in Hong Kong–a single center study. BMC infectious diseases, 19(1), 156. https://doi.org/10.1186/s12879-019-3784-y

Sheng, B., Law, C. B., & Yeung, K. M. (2009). Characteristics and diagnostic profile of patients seeking dementia care in a memory clinic in Hong Kong. International psychogeriatrics, 21(2), 392-400. https://doi.org/10.1017/S104161020800817X

A study has found a cross-sectional association between neighbourhood economic disadvantages and prevalence of dementia among 21,008 older adults aged 65 years and over. Data were extracted from 18 Elderly Health Centres of the Department of Health from 2009 to 2011. The results suggested that the higher the neighbourhood economic disadvantage, the higher the prevalence of dementia in the neighbourhood (Guo et al., 2019).

References:

Guo, Y., Chan, C. H., Chang, Q., Liu, T., & Yip, P. S. (2019). Neighborhood environment and cognitive function in older adults: A multilevel analysis in Hong Kong. Health & place, 58, 102146. https://doi.org/10.1016/j.healthplace.2019.102146

The Visiting Health Teams of the Department of Health (DH) organise regular health promotion activities such as health talks and support groups in 18 Elderly Health Centres across the 18 districts in Hong Kong. Reducing the risk of dementia is one of their major goals. Their monthly topics in relation to dementia include healthy lifestyle, exercise and eating, no smoking education, weight management, accident prevention and home safety, mental health check, and other common age-related disease management, such as hypertension, heart disease, stroke, diabetes mellitus, and Parkinson’s disease (Elderly Health Service, 2020, March 26).

Moreover, the Social Welfare Department (SWD) has launched a 3-years “Dementia Friendly Community Campaign” in 2018, which provides public education programmes to increase public awareness, reduce risks, and enhance care of persons with dementia and their family members (more details can be found in Part 5). This campaign emphasises the following advices on reducing risk of dementia (Social Welfare Department, 2018, December):

• Prevention of cerebrovascular diseases;
• Maintain healthy lifestyle;
• Maintain active social life and develop personal hobbies;
• Regular body check and cognitive assessment;
• Keep a positive mind;
• Reduce the chance of brain injury;
• Develop daily participation in aerobic and mind-body exercises;
• Develop Six Arts multi-cognitive domains (i.e., interpersonal and social, musical, visual-spatial, kinesthetic, linguistic, and logic-mathematical elements).

References:

Elderly Health Service, Department of Health. (2020, March 26). Visiting Health Team: Health Promotion Activities (Regular Topics). Retrieved from https://www.elderly.gov.hk/english/service_providers/promotion.html

Social Welfare Department. (2018, December). Dementia Awareness Kit. Hong Kong Retrieved from https://www.swd.gov.hk/dementiacampaign/en/doc/Dementia_Awareness_kit_en.pdf.

Various modifiable risk factors for dementia are identified in Hong Kong, including family history, gender, low education attainment, physical inactivity, social isolation, depression, head injury, smoking, and alcohol drink habit. In addition, some non-communicable diseases are also found to be associated with the risk of dementia, such as hypertension, high blood cholesterol, diabetes mellitus, coronary heart disease, stroke, overweight, and obesity (Department of Health, 2017c).

References:

Department of Health. (2017c). Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment.  Retrieved from https://www.fhb.gov.hk/pho/english/resource/files/Module_on_Cognitive_Impairment.pdf.

The education level of most elderly people is primary in Hong Kong. In 2018, there are 37.2% of people aged 60 and over with primary education in which 39.8% are female and 34.4% are male (Census and Statistics Department, 2019j).

References:

Census and Statistics Department. (2019j). Women and Men in Hong Kong – Key Statistics 2019 Edition. Hong Kong Retrieved from https://www.statistics.gov.hk/pub/B11303032019AN19B0100.pdf

In 2018, there are 18.3% of people aged 60 and above with lower secondary education in which 15.6% are female and 21.2% are male. There are 21.1% of people aged 60 or above with upper secondary education in which 18.4% are female and 24.1% are male (Census and Statistics Department, 2019j).

References:

Census and Statistics Department. (2019j). Women and Men in Hong Kong – Key Statistics 2019 Edition. Hong Kong Retrieved from https://www.statistics.gov.hk/pub/B11303032019AN19B0100.pdf

According to the population health survey in 2014/2015, the overall prevalence of self-reported doctor-diagnosed hypertension was 17.8% (17.9% for females and 17.6% for males) for people aged 15 and above. The prevalence of hypertension rapidly increases from 45.8% for people aged 65-74 to 61.2% for people aged 85 and above (Centre for Health Protection, 2017).

References:

Centre for Health Protection. (2017). Report of Population Health Survey 2014/15. Retrieved from https://www.chp.gov.hk/en/static/51256.html

According to the population health survey in 2014/2015, the overall prevalence of obesity was 29.9% and overweight was 20.1% among people aged 15-84. Females aged 65-84 (34.3%) and males aged 45-54 (51.1%) were the most common age groups having obesity (Centre for Health Protection, 2017).

References:

Centre for Health Protection. (2017). Report of Population Health Survey 2014/15. Retrieved from https://www.chp.gov.hk/en/static/51256.html

According to the population health survey in 2014/2015, 2.2% of people aged 15 and above (2.1% for females and 2.2% for males) had self-reported doctor- or audiologist-diagnosed hearing impairment or loss. The prevalence increased rapidly from 4.6% among people aged 65-74 to 18.8% among people aged 85 and above (Centre for Health Protection, 2017).

References:

Centre for Health Protection. (2017). Report of Population Health Survey 2014/15. Retrieved from https://www.chp.gov.hk/en/static/51256.html

According to the population health survey in 2014/2015, 27.1% of people aged 15 and above (10.8% for females and 45.0% for males) had ever smoked cigarettes. Among the elderly population, the proportion of people aged 65-74, 75-84 and ≥85 who ever smoked were 31.2%, 32.9%, and 26.1% respectively (Centre for Health Protection, 2017). Furthermore, among these people who had ever smoked cigarettes, 54.6% (49.3% for females and 56.0% for males) currently had the habit of smoking. The proportion of smokers were highest in the age group of 35 – 44 (66.9%) and lowest in the age of 85 and above (13.8%) (Centre for Health Protection, 2017).

 References:

Centre for Health Protection. (2017). Report of Population Health Survey 2014/15. Retrieved from https://www.chp.gov.hk/en/static/51256.html

According to the population health survey in 2014/2015, 0.8% of people aged 15 and above (1.1% for females and 0.5% for males) had self-reported doctor-diagnosed depression. The prevalence was the highest among people aged 65-74 at 1.4% (Centre for Health Protection, 2017).

References:

Centre for Health Protection. (2017). Report of Population Health Survey 2014/15. Retrieved from https://www.chp.gov.hk/en/static/51256.html

According to the population health survey in 2014/2015, 13.0% of people aged 18 and above (14.2% for females and 11.6% for males) had insufficient physical activity according to WHO’s definition. The prevalence was the highest among people aged 85 and above at 36.1% (Centre for Health Protection, 2017).

References:

Centre for Health Protection. (2017). Report of Population Health Survey 2014/15. Retrieved from https://www.chp.gov.hk/en/static/51256.html

According to the population health survey in 2014/2015, 5.5% of the population aged 15 and above (5.6% for females and 5.4% for males) had doctor-diagnosed diabetes mellitus. The prevalence increased with age to a peak of 22.7% among people aged 75-84. More detailed information related to proportion of different age groups and gender are shown in Part 1 (Centre for Health Protection, 2017).

References:

Centre for Health Protection. (2017). Report of Population Health Survey 2014/15. Retrieved from https://www.chp.gov.hk/en/static/51256.html

According to the health fact statistics released by the Department of Health, in 2016, prevalence of daily alcohol drinking in Hong Kong was 2.8% for the population aged 18-64 (4.3% for male and 1.8% for female) (Department of Health, 2018). For further breakdown by age groups, according to an earlier population health survey in 2014/2015, the prevalence was the highest at 5.1% for the age group of 75-84 (Centre for Health Protection, 2017). In 2018, the alcohol consumption per capita was 2.85 litres among people aged 15 and above in Hong Kong (Department of Health, 2020, March 5).

References:

Centre for Health Protection. (2017). Report of Population Health Survey 2014/15. Retrieved from https://www.chp.gov.hk/en/static/51256.html

Department of Health. (2018). Health Facts of Hong Kong 2018 Edition. Retrieved from https://www.dh.gov.hk/english/statistics/statistics_hs/files/Health_Statistics_pamphlet_E.pdf

Department of Health. (2020, March 5). Alcohol Consumption Per Capita in Hong Kong. Retrieved from https://www.change4health.gov.hk/en/alcohol_aware/figures/alcohol_consumption/index.html

According to the population health survey in 2014/2015, 14.4% of the population aged 15 and above (14.0% for females and 14.8% for males) had high blood cholesterol. The prevalence increased with age to a peak of 39.0% for the people aged 75-84. More detailed information related to the proportion of different age groups and gender are described in Part 1 (Centre for Health Protection, 2017).

References:

Centre for Health Protection. (2017). Report of Population Health Survey 2014/15. Retrieved from https://www.chp.gov.hk/en/static/51256.html

Private general practitioners, family doctors and doctors at general out-patient clinics in public hospitals are usually the first point of contact, who play an important role in detecting and diagnosing dementia in the community, and referring people with dementia and suspected cases to specialist care in Hospital Authority or to the private sector for further investigation (Food and Health Bureau, 2017a). Older adults may need to undergo several and sometimes repeated tests from different service providers before a formal diagnosis can be made. As family doctors may not have relevant expertise and multi-disciplinary support to make a diagnosis, and not all older adults can afford the services in the private sector, thus, they usually rely on services of public hospitals. The major role of formal diagnosis lies in the public sector.

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

According to the findings of the prevalence study conducted by Department of Health and Chinese University of Hong Kong in 2005 (Elderly Commission, 2005), among the 70,000 community-living older people suffering from dementia, 89% of them are not known to any medical services, which means 11% of people with dementia have received a diagnostic assessment at that time. No more updated figures on the diagnostic rate are available.

References:

Elderly Commission. (2005). Prevalence of dementia in Hong Kong. Retrieved from https://www.elderlycommission.gov.hk/en/download/meeting/Study%20on%20Prevalence%20of%20dementia.pdf

There is no information available regarding the number of people who received a diagnostic assessment in the most recent year of a specific year. In year 2015-2016, about 28,000 people with dementia were receiving specialist care in Hospital Authority mainly provided by the Department of Psychiatry and the Department of Medicine (Food and Health Bureau, 2017a). The number of diagnosis assessment provided by the private sector is not clear.

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Rural-urban division is not applicable in Hong Kong as, according to the World Bank, the urban population accounts for 100% of its total population since 1993.

Local evidence on the impact of socio-economic factors on receiving diagnostic assessment is relatively limited. A study (Tang et al., 2016) comparing the characteristics of early help seekers (i.e., seek help within a year since noticing the first symptom) and late help seekers, finds that the early help seekers are more likely to live in private housing. It also suggests that people with better socio-economic status may facilitate earlier help seeking.

References:

Tang, J. Y. M., Wong, G. H. Y., Ng, C. K. M., Kwok, D. T. S., Lee, M. N. Y., Dai, D. L. K., & Lum, T. Y. S. (2016). Neuropsychological profile and dementia symptom recognition in help-seekers in a community early-detection program in Hong Kong. Journal of the American Geriatrics Society, 64(3), 584-589. http://dx.doi.org/10.1111/jgs.13938

For healthcare, Hospital Authority is the main coordinator of dementia care. For long-term care, Social Welfare Department and the NGO-operated District Elderly Community Centres are the main coordinators. Since the implementation of Dementia Community Support Scheme in 2017, the two sectors have been collaborating more closely and frequently in the management of dementia care (Social Welfare Department, 2020c).

References:

Social Welfare Department. (2020c). Dementia Community Support Scheme. Retrieved from https://www.swd.gov.hk/dementiacampaign/en/info_5.html

Yes. The Hong Kong Alzheimer’s Disease Association, a self-financing NGO, is providing dementia-specific services, including day care services and non-pharmacological interventions provided by 4-day centres and in-home services. Moreover, at least 9 other NGOs have been providing self-financing dementia-specific centres/services in the community, including: 1) CFSC Mind: Delight Memory and Cognitive Training Centre; 2) ELCHK Smart Club; 3) HKSR Community Rehabilitation Network; 4) Jockey Club Centre for Positive Ageing; 5) Pok Oi Hospital Day Centre for the Elderly (Yuen Long); 6) St James’ Settlement Kin Chi Dementia Care Support Service Centre; 7) TWGHs Circle of Care – Community Support Network for Elders with Dementia; 8) Yan Chai Hospital Yim Tsui Yuk Shan Active Mind Centre; and 9) Yan Oi Tong Clarea Au Eldergarten (The Hong Kong Alzheimer’s Disease Association, 2020).

The Dementia Community Support Scheme, a publicly funded programme implemented by the Food and Health Bureau, Hospital Authority, and Social Welfare Department, was also designed exclusively for people with dementia. Through medical-social collaboration, people with dementia who receive diagnosis in public hospitals are referred to a district elderly community centre for interventions and carers training. Services for everyone are provided according to the individualised care plan formulated by professionals from both the healthcare and social care sectors.

References:

The Hong Kong Alzheimer’s Disease Association. (2020). Organizations provided dementia-related service in Hong Kong. Retrieved from https://www.eng.hkada.org.hk/useful-links

These services are all connected by service referrals made by professionals. These links are strongly maintained by the professional training of various types of profession involved and the referral guidelines of each party. Primary care such as private clinic of a general practitioner is usually the first point of contact of people suspected of dementia. Depending on the affordability and preferences of the older adults, referrals will be made to a specialist clinic in a public hospital or another private clinic for further investigation or diagnosis. After receiving a diagnosis, the medical team will formulate individualised treatment plans for the people with dementia, provide them with medication, cognitive training and rehabilitation services, and refer them to suitable social service agencies for follow-up in the community according to their needs. In order to use subsidised community or residential care services, same as for other older adults, people with dementia need to go through the needs assessments regulated by the Social Welfare Department.

Apart from the path previously mentioned, older adults often become in need of care before developing dementia. If existing community care service users were suspected of dementia, their service providers would be their first point of contact and would refer them to a specialist for diagnosis directly.

Not at the macro level, but yes for individual parties within their organisations. Each organisation, such as the Hospital Authority, the Social Welfare Department, and NGOs operated service providers, has internal protocols or practice guidelines regarding the responsibility of each type and rank of staff and when to refer cases to another department within the organisation or to an external party. Yet, there is no overarching protocol or policy guiding the development of these practice guidelines in the first place.

Mirroring on the seven-stage model for planning dementia services suggested by the WHO and the Alzheimer’s Disease International, the Food and Health Bureau has depicted the dementia care services in Hong Kong and the responsibilities of each party, reported in page 151 of the Mental Health Review Report (Food and Health Bureau, 2017a).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Yes. For public healthcare services, 5% of the cost has to be covered by users and the remaining 95% is subsidised by the Government (Food and Health Bureau, 2010). Individuals with more financial difficulties may apply for medical fee waiver such that there will be no out-of-pocket payments when using public healthcare services (Hospital Authority, 2019d). The service fees of public services offered by the Hospital Authority and commonly used by people with dementia are specialist outpatient (HK$135 for the 1st attendance, $80 per subsequent attendance, $15 per drug item), general outpatient ($50 per attendance), geriatric day hospital ($60 per attendance) and rehabilitation day hospital services ($55 per attendance) (Hospital Authority, 2020d).

For private healthcare services, the Hong Kong Medical Association has been conducting surveys on doctors’ fees every four years since 1991, with the aim to gather information on the prevailing charges of medical services in the private sector. According to the latest survey conducted in 2018 (Hong Kong Medical Association, 2019), the median service charge (medication inclusive) of specialists for regular clinic consultation and psychiatry consultation (half-hour) are $800 and $900 respectively. Under the Health Care Voucher Scheme implemented by the Government, older adults age over 65 may make use of the annual voucher amount of $2000 to cover their medical expenses in the private sector.

For public social care services, under the Dementia Community Support Scheme, people with dementia can receive care and support services, training and carer support services provided by District Elderly Community Centres (operated by NGOs). Recipients of Comprehensive Social Security Assistance or Old Age Living Allowance, and holders of medical fee waiver can receive free-of-charge service. Other users have to pay $150 per month to receive support under this scheme (Food and Health Bureau, 2019a). For other care services provided by NGOs under governmental subvention, most of the services are free-of-charge or they charge a very small amount.

For care services provided by dementia-specific service centres operated by self-financing NGOs, people with dementia will experience a higher amount of out-of-pocket payments. For instance, according to the Hong Kong Alzheimer’s Disease Association, the service fee of day care services is $340 – 420 per day (meals included) (Hong Kong Alzheimer’s Disease Association, 2020b); while according to the Jockey Club Centre for Positive Ageing, the service fee of day care services is $435 – 565 per day (meals included) (Jockey Club Centre for Positive Ageing, 2020b).

References:

Food and Health Bureau. (2010). My Health My Choice – Healthcare Reform Second Stage Consultation Document. Retrieved from https://www.myhealthmychoice.gov.hk/pdf/consultation_full_eng.pdf

Food and Health Bureau. (2019a, 4 June, 2019). Dementia Community Support Scheme. Retrieved from https://www.fhb.gov.hk/en/press_and_publications/otherinfo/180500_dcss/dcss_index.html

Hong Kong Alzheimer’s Disease Association. (2020b). Services – Day Centres. Retrieved from https://www.eng.hkada.org.hk/day-centres

Hong Kong Medical Association. (2019). Hong Kong Medical Association Doctors’ Fees Survey 2018. Retrieved from Hong Kong: https://www.thkma.org/pressrelease/details/20190125_a1.pdf

Hospital Authority. (2019d). Waiting Time for New Case Booking at Psychiatry Specialist Out-patient Clinics. Retrieved from https://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=214197&Lang=ENG&Dimension=100&Parent_ID=10053

Hospital Authority. (2020d). Service Guides – Fee and Charges. Retrieved from https://www.ha.org.hk/visitor/ha_visitor_index.asp?Parent_ID=10044&Content_ID=10045&Ver=HTML

Jockey Club Centre for Positive Ageing. (2020b). Service – Day Care Service. Retrieved from https://www.jccpa.org.hk/en/service/day_care_service/index.html

In Hong Kong, older adults including people with dementia must go through the Standardised Care Need Assessment Mechanism for Elderly Services to access subsidised long-term care service. The mechanism was implemented from November 2000 by the Social Welfare Department (Social Welfare Department, 2020i). Under the Mechanism, an internationally recognised assessment tool, the so-called Minimum Data Set-Home Care (MDS-HC) is adopted to ascertain the care needs of the elderly and match them with appropriate services. People in need can contact Social Welfare Department or social services providers for assessment on eligibility of subsidised long-term care services. The individuals opting for long-term care provided by the private sector, for instance residential care service, can contact the service provider directly.

References:

Social Welfare Department. (2020i). Standardised Care Need Assessment Mechanism for Elderly Services. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_standardis/

Three previous studies provided the estimates of the cost of dementia in Hong Kong. All of them include costs from a societal perspective. According to Wimo et al., (2007; 2010), the estimates of their studies consist of the direct cost and informal care cost. For informal care cost, three options of informal care are used: i) 1.6 hours/day for basic ADLs, ii) 3.7 hours/day for basic ADLs and IADLs, and iii) 7.4 hours/day for basic ADLs, IADLs and supervision. The total cost under option ii) estimated in 2005 and 2009 were HK$11,479 million and HK$15,684 million, respectively. Moreover, the study conducted by Yu et al. (2010), provides the estimates of the cost of dementia in 2010 (HK$12,220 million) and the projected cost in 2036 (HK$31,810 million). It includes hospitalisation costs, institutional (i.e., residential) care costs, and informal care costs in their estimation.

References:

Wimo, A., Winblad, B., & Jönsson, L. (2007). An estimate of the total worldwide societal costs of dementia in 2005. Alzheimer’s & Dementia, 3(2), 81-91. https://doi.org/10.1016/j.jalz.2007.02.001

Wimo, A., Winblad, B., & Jönsson, L. (2010). The worldwide societal costs of dementia: Estimates for 2009. Alzheimer’s & Dementia, 6(2), 98-103. https://doi.org/10.1016/j.jalz.2010.01.010

Yu, R., Chau, P. H., McGhee, S. M., Cheung, W. L., Chan, K. C., Cheung, S. H., & Woo, J. (2010). Dementia Trends: Impact of the Ageing Population and Societal Implications for Hong Kong. In. Hong Kong: The Hong Kong Jockey Club Charities Trust.

Yes. For healthcare services, the Hospital Authority provides Community Nursing Service and Community Psychiatric Nursing Service delivered by qualified community nurses. These services aim at providing nursing care during home visits and at equipping people with dementia and their families with self-care ability and carer skills to cope with their needs.

For long-term care services, community care service as a whole aims at providing “personal care, nursing care, rehabilitation training, and social activities in a familiar home and community environment to frail elders who cannot receive care from their family members during day-time” (Social Welfare Department, 2020e). There are currently 41 District Elderly Community Centres (DECCs), 76 Day Care Centres/Units for the Elderly (DEs/DCUs), 34 Enhanced Home and Community Care Services (EHCCS), and 60 Integrated Home Care Services Teams (IHCSTs) providing services for elderly and family in need. All these services cover people with dementia.

References:

Social Welfare Department. (2020e). Introduction of Community Care Services. Retrieved from https://elderlyinfo.swd.gov.hk/en/ccs_introduction.html

Yes. Although specialists in the public sector (i.e., Hospital Authority) are the main providers of diagnostic services in Hong Kong, there are available diagnostic services in primary care in the private sector:

1. Primary care physicians with specialist qualifications are able to provide diagnosis. By the end of 2016, there are 118 specialists registered under neurology and 355 specialists registered under psychiatry in Hong Kong (The Medical Council of Hong Kong, 2016). Some of these specialists work in primary care settings but the exact number is unknown.
2. Some primary care physicians receive dementia training. For example, in year 2016/2017, 132 and 51 physicians have successfully completed basic and advanced courses for doctors in dementia provided by the Hong Kong Alzheimer’s Disease Association. 480 people with suspected dementia have received diagnostic service under the Early Detection Service of Hong Kong Alzheimer’s Disease Association (Hong Kong Alzheimer’s Disease Association, 2017).

References:

Hong Kong Alzheimer’s Disease Association. (2017). 2016/17 Annual Report. Retrieved from https://87bdf434-9adb-480e-b8f9-9239b0ceb722.filesusr.com/ugd/85d328_b73ba35a8c0b45f2ac5e26a9f18050ca.pdf

The Medical Council of Hong Kong. (2016). Annual Report 2016. Retrieved from https://www.mchk.org.hk/files/annual/files/2016/MCAR_2016_e.pdf

Yes. From the social care sector, to ensure better care and safety of elderly people with dementia, the Social Welfare Department has allocated resources to subsidise Day Care Units, which can provide assessments and dementia-specific services for people with dementia, including cognitive training, memory training, reality orientation, reminiscence therapy, etc (Legislative Council, 2017).

Moreover, the Dementia Community Support Scheme has enabled District Elderly Community Centres to provide support services for people with mild or moderate dementia and their carers. The scheme incorporates interventions targeting BPSD as an additional module depending on the needs of the service users.

References:

Legislative Council. (2017). Support for Persons Suffering from Dementia and their Family Members. Hong Kong Retrieved from https://www.legco.gov.hk/yr17-18/english/panels/ws/papers/ws20171211cb2-452-6-e.pdf.

Yes. Like the assessment and management of BPSD mentioned above, Day Care Units and District Elderly Community Centres offer psychosocial services and rehabilitation services to people with dementia.

From the healthcare sector, multi-disciplinary teams led by doctors in public hospitals also plan and provide day rehabilitation services in line with the needs of the people with dementia (Legislative Council, 2017).

References:

Legislative Council. (2017). Support for Persons Suffering from Dementia and their Family Members. Hong Kong Retrieved from https://www.legco.gov.hk/yr17-18/english/panels/ws/papers/ws20171211cb2-452-6-e.pdf.

Yes. Day Care Units and Home Care Teams are integral parts of the long-term care service that provide ADLs support services to older adults in need of care, including people with dementia.

Further, in the Dementia Community Support Scheme, independent community living with a skill training programme, are major themes of training under functional training, which mainly focusses on enhancing PwDs’ instrumental activities of daily living (Task Force on Dementia Community Support Scheme, 2017a).

References:

Task Force on Dementia Community Support Scheme. (2017a). Operations Guideline on Dementia Community Support Scheme.

No. Hong Kong has a centrally-funded comprehensive palliative care service coordinated by the government under the auspices of the Hospital Authority. As for 2019, there are 17 palliative care services (Lam, 2019) and there are about 400 beds for palliative care provided by public hospital and NGOs (Ng, 2018). However, there are no dementia-specific palliative and end-of life care services.

References:

Lam, W. M. (2019). Palliative care in Hong Kong – past, present and future. Hong Kong Practitioner, 41(2), 39-46. Retreived from: https://www.hkcfp.org.hk/Upload/HK_Practitioner/2019/hkp2019vol41Jun/discussion_paper.html

Ng, F. (2018). 香港临终关怀现状与发展. Retrieved from https://www.hkcchp.org/pdf/%E9%A6%99%E6%B8%AF%E4%B8%B4%E7%BB%88%E5%85%B3%E6%80%80%E7%8E%B0%E7%8A%B6%E4%B8%8E%E5%8F%91%E5%B1%95_20180823.pdf

Yes. Please refer to ‘Part 9: Social Protection for People with Dementia’.

No. The community-based services provided by the healthcare sector and by the long-term care sector are territory-wide.

Both.

The estimates in relation to dementia are not available.

Yes. The Dementia Community Support Scheme is a recently implemented mechanism to coordinate care across health and long-term care, which is launched by the Food and Health Bureau, the Social Welfare Department, and the Hospital Authority. It provides territory-wide support services to people with mild or moderate dementia and to their carers through a medical-social collaboration model (Social Welfare Department, 2020c). Advanced care nurses from Hospital Authority, nurses, social workers, occupational therapists and/or physiotherapists in District Elderly Community Centres work together to plan for inter-disciplinary care for people with dementia.

Besides, there is a Certi­fied Dementia Care Planner (CDCP) Course o­ffered by the Institute of Alzheimer’s Education of Hong Kong Alzheimer’s Disease Association, to train professional care planners who are equipped with comprehensive skills and knowledge about dementia care and can then provide continuity of care walking through the caring journey with families living with dementia, acting as coordinators with di­fferent dementia care teams in community, residential, and hospital settings (Hong Kong Alzheimer’s Disease Association, 2020a).

References:

Hong Kong Alzheimer’s Disease Association. (2020a). Certified Dementia Care Planner (CDCP) Course. Retrieved from http://ageing.hku.hk/upload/file/CDCP-8_flyer_new.pdf

Social Welfare Department. (2020c). Dementia Community Support Scheme. Retrieved from https://www.swd.gov.hk/dementiacampaign/en/info_5.html

Yes. Since the information provided by carers and family members is usually considered very important for identifying symptoms, the process of diagnosis usually involves family carers’ participation. The Department of Health has recommended that input from family and caregiver is often needed in dementia diagnostic services (Department of Health, 2017a).

References:

Department of Health. (2017a). Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings: Module on Cognitive Impairment.

Both pharmacological and non-pharmacological interventions are available. For pharmacological interventions, please refer to section 07.05. For non-pharmacological interventions, rehabilitation day hospitals and NGO-operated community care service units provide a wide range of interventions, including but not limited to, cognitive training, occupational therapy, reality orientation therapy, reminiscence therapy, validation therapy, multisensory stimulation intervention, physical exercise programme, cognitive stimulation therapy, music therapy, aromatherapy, carer educational programme, and carer stress-reduction interventions. Yet, owing to the diversity of the practices of service providers, there is no comprehensive statistics on the provision of different types of non-pharmacological interventions available.

Cognitive stimulation therapy, for instance, is one of the group-based therapies that emphasises on the social interactions among the participants.

For residents in the Islands Districts, there will be less provision of community-based services compared with people living in more central districts. They rely on home-based services provided by providers from another district.

Yes. There are 60 integrated home care services teams, providing a range of community support services to the elderly, to people with disabilities and to needy families living in the community. Also, there are 34 enhanced home and community care teams providing services to meet the nursing and care needs of the frail and the elderly (Social Welfare Department, 2020a).

In terms of availability, though the home care services have covered all districts in Hong Kong, for remote Island Districts, some services might be limited compared to the other districts. For example, while all previous Home Help Teams have been upgraded to Integrated Home Care Services Teams since 2003, one service unit in Tung Chung, in Lantau Island, remains acting as Home Help Team.

References:

Social Welfare Department. (2020a). Community Care and Support Services for the Elderly. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_csselderly/

Yes. For healthcare specialist services, referral from general practitioners or another speciality is required. For subsidised long-term care services, older adults have to be assessed as moderately or severely impaired via the Standardised Care Need Assessment Mechanism for Elderly Services (Legislative Council, 2017).

References:

Legislative Council. (2017). Support for Persons Suffering from Dementia and their Family Members. Hong Kong Retrieved from https://www.legco.gov.hk/yr17-18/english/panels/ws/papers/ws20171211cb2-452-6-e.pdf.

Yes, the Hong Kong Alzheimer’s Disease Association (HKADA), which is the only member of the Alzheimer’s Disease International in Hong Kong.

The Hong Kong Alzheimer’s Disease Association has one head office located in Kowloon, one Institute of Alzheimer’s Education (IAE), and four regional day centres: Brain Health Centre (Lok Fu, Kowloon), Jean Wei Centre (Wan Chai, Hong Kong Island), Tseung Kwan O Integrated Service Centre (Tseung Kwan O, NT), and Gene Hwa Lee Centre (Tsuen Wan, NT) (Hong Kong Alzheimer’s Disease Association, 2020b).

References:

Hong Kong Alzheimer’s Disease Association. (2020b). Services – Day Centres. Retrieved from https://www.eng.hkada.org.hk/day-centres

Not clear, stakeholder interview needed.

The HKADA mainly provides four types of services (Hong Kong Alzheimer’s Disease Association, 2020b):

1. Early Detection Service, which provides comprehensive assessments to speed up the diagnostic process.
2. Day Centres, which aim at maintaining clients’ existing functions and at delaying further cognitive deterioration as well as alleviating caregivers’ stress by using non-pharmacological therapies as well as different structured and suitable training.
3. In Home Service. In order to maintain clients’ abilities and daily functioning and to reduce the effects of the disease to the minimum, this service will design comprehensive care plans and implement home-based training by prescribing different therapeutic interventions, as well as render professional advices for caregivers on home care management and behavioral management techniques.
4. The Institute of Alzheimer’s Education (IAE) aims at providing training and educational courses for medical and social service practitioners, caregivers, and general public, in order to raise understanding of dementia and to build the capacity for quality dementia care. The HKADA is also playing its role of dementia education in echoing to the Dementia Friends initiative of Alzheimer’s Society in the United Kingdom since 2017, to encourage all walks of life in Hong Kong to become Dementia Friends and motivate the public to translate care and acceptance of people with dementia into action.

In addition, they are now implementing two special projects:

1. Project e+: Dementia Community Support Service. Project e+ is a collaborative activity with Kwai Tsing District Office aiming to raise community awareness of the dementia issue through sustained publicity campaigns, to enhance early detection of dementia patients for timely interventions, and to provide concrete support to dementia patients and their families.
2. 4E’s Action for Dementia: Early detection, Early diagnosis, Early intervention, and Early planning. Sponsored by Ronald and Rita Mcaulay Foundation. This project targets Early detection, Early diagnosis, Early intervention, and Early planning by providing Early Detection Service, Community Memory Clinic, day centre services, Care planning consultation, and Emotional support.

References:

Hong Kong Alzheimer’s Disease Association. (2020b). Services – Day Centres. Retrieved from https://www.eng.hkada.org.hk/day-centres

The regular services are not funded by the government. For the special project – Project e+ in collaboration with Kwai Tsing District Office – government funding may be involved but details are not clear.

No. There is no evidence showing that the HKADA has been involved in the policy development related to dementia in Hong Kong.

Overall, NGOs are providing territory-wide elderly community centres, day care centres, and home care services.

Yes. Please refer to question 07.01.08.

No information regarding their profiles is available.

For subsidised NGO services, breakdowns in relation to dementia is not available.

For self-financing NGO services, for instance, in year 2018/2019, the Hong Kong Alzheimer’s Disease Association provided day services to 512 persons, early detection services to 356 individuals, family caregiver support and public education activities to 16,020 individuals, and professional trainings to 535 professionals or frontline workers in year 2018/2019 (Hong Kong Alzheimer’s Disease Association, 2019).

References:

Hong Kong Alzheimer’s Disease Association. (2019). Annual Report 2018/19. Retrieved from https://87bdf434-9adb-480e-b8f9-9239b0ceb722.filesusr.com/ugd/85d328_ce8758bd23014cda850e2a487b7cb432.pdf

There are 118 specialists registered under neurology out of 6797 registered medical practitioners in the Specialist Register in 2016 (The Medical Council of Hong Kong, 2016).

References:

The Medical Council of Hong Kong. (2016). Annual Report 2016. Retrieved from https://www.mchk.org.hk/files/annual/files/2016/MCAR_2016_e.pdf

There are 355 specialists registered under psychiatry out of 6797 registered medical practitioners in the Specialist Register in 2016 (The Medical Council of Hong Kong, 2016).

References:

The Medical Council of Hong Kong. (2016). Annual Report 2016. Retrieved from https://www.mchk.org.hk/files/annual/files/2016/MCAR_2016_e.pdf

Yes.

Yes, for occupational therapists.

The Social Welfare Department regularly organises trainings for professional staff (including social work staff and allied health professionals) and non-professional staff (including care workers and health workers) from elderly service units to enhance their knowledge of dementia and to strengthen their skills in caring for elderly people with dementia. In 2016-17, a total of 484 staff, including 290 non-professional staff and 194 professional staff, attended the training programmes.

Yes, by the Department of Health. For details, please refer to Part 8.

Psychologists and therapists are covered under 07.03.02.

For other professionals such as receptionists and security guards, dementia information sessions and short-term workshops are provided to some of them under the campaigns of dementia friendly city. For more details, please refer Part 5. Yet, these trainings are not comparable to the professional training received by the long-term care workforce.

Yes. Residential Care Homes for the Elderly can generally be classified into four types according to their financing mode: subvention homes, contract homes (residential care homes which obtain their service contract through bidding), non-profit-making self-financing homes, and private homes (Social Welfare Department, 2020g).

References:

Social Welfare Department. (2020g). Overview of Residential Care Services for the Elderly. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_residentia/id_overviewon/

Yes. In the public sector, there are 17 palliative care services under the auspices of the Hospital Authority in 2019 (Lam, 2019). In the private sector, The Jockey Club Home for Hospice which started its services in 2017, provides quality hospice and palliative care to patients with life-limiting illnesses and their families (The Society for the Promotion of Hospice Care, 2020).

References:

Lam, W. M. (2019). Palliative care in Hong Kong – past, present and future. Hong Kong Practitioner, 41(2), 39-46. Retreived from: https://www.hkcfp.org.hk/Upload/HK_Practitioner/2019/hkp2019vol41Jun/discussion_paper.html

The Society for the Promotion of Hospice Care. (2020). Jockey Club Home for Hospice. Retrieved from https://www.hospicecare.org.hk/service-detail.php?id=22&lang=en

Yes. As of March 2020, there are 87 government subsidised day care centres and 80 self-financing day care centres (Social Welfare Department, 2020b). Older people aged 60 and over being assessed by Care Need Assessment Mechanism for Elderly Services and having moderate or severe level of impairment, are suitable for day care service provided by Social Welfare Department, otherwise they can select self-financed services.

References:

Social Welfare Department. (2020b). Day Care Centres/Units for the Elderly. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_csselderly/id_daycarecen/

Yes. There are 41 District Elderly Community Centres and 169 Neighbourhood Elderly Centres providing the following services: Collaboration with and provision of support to other elderly service units in the district, Community education, Case management, Reaching out and networking, Support team for the elderly, Health education, Educational and developmental activities, Provision of information on community resources and referral services, Volunteer development, Carer support services, Counselling service, Educational and supportive programmes on dementia, Social and recreational activities, Meal and laundry services, Drop-in service, etc.

There are 953 residential care homes for the elderly providing 76,343 beds in total (Social Welfare Department, 2020g).

References:

Social Welfare Department. (2020g). Overview of Residential Care Services for the Elderly. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_residentia/id_overviewon/

Not clear.

No.

Not clear, although most public inpatient services are used by older adults.

Regarding public hospitals under Hospital Authority, by the end of 2016 there were 28,000 people with dementia receiving care in HA (Food and Health Bureau, 2017a), but whether they have been hospitalised is not clear.

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Please refer to the answer for item 07.04.01.

Listed above in item 07.04.01.04.

Yes, especially after the regular implementation of the Dementia Community Support Scheme (DCSS) since 2020, all the 41 so-called ‘District Elderly Community’ provide dementia specific programmes (Task Force on Dementia Community Support Scheme, 2017b). Interventions targeting cognitive performance, functional ability, carer burden, psychosocial wellbeing, behavioural and psychological symptoms of dementia, and physical co-morbidities are provided.

References:

Task Force on Dementia Community Support Scheme. (2017b). Operations Guideline on Dementia Community Support Scheme.

No, or probably a very limited role. For people with dementia who are aged under 60 but in need of hospital care or residential care, they may be referred to psychiatric inpatient service or Long Stay Care Home. Yet, there is no information about this group of people with dementia.

There are four major types of anti-dementia medications approved by the Hospital Authority Drug Formulary in Hong Kong (Hospital Authority Drug Formulary, 2020, April 10; Institute of Mental Health Castle Peak Hospital, 2020), including Donepezil (Aricept), Rivastigmine (Exelon), Galantamine (Reminyl), and Memantine (Ebixa). They are commonly used in treating dementia for slowing down disease progression, maintaining functioning, deferring decline, and alleviating behavioural and emotional problems. Apart from that, other drugs may be also used to ease some distressing symptoms relating to dementia at different stages, such as depression, anxiety, sleeping disorder, and antipsychotics (Social Welfare Department, 2018).

References:

Hospital Authority Drug Formulary. (2020, April 10). HA DRUG FORMULARY (v15.4 – w.e.f.10 Apr 2020)

Institute of Mental Health Castle Peak Hospital. (2020). Anti-dementia agents.

Social Welfare Department. (2018). Dementia Awareness Kit.

The four major types of anti-dementia medications are special drugs that are available as generics in the Hospital Authority (HA) in Hong Kong. They are prescribed by specialists for dementia patients who have been assessed as having specified clinical conditions and therapeutic needs. For dementia patients who do not have the specified clinical conditions, they must only purchase these drugs with a prescription in HA pharmacies or community pharmacies as self-financed items (Hospital Authority Drug Formulary, 2020, February 8; The Government of the Hong Kong SAR, 2015, February 25).

References:

Hospital Authority Drug Formulary. (2020, February 8). Self-financed Drugs Available for Purchase by Patients at HA Pharmacies.

The Government of the Hong Kong SAR. (2015, February 25). LCQ17: Dementia [Press release]. Retrieved from https://www.info.gov.hk/gia/general/201502/25/P201502250512.htm

No. Adult hygiene products (e.g., diapers, disposable cloths, underpads) are not subsidised for people with dementia in Hong Kong.

No. Assistive technology products (e.g., walking frames, wheelchairs, spectacles, hearing aids) are not subsidised for people with dementia in Hong Kong.

For most of the cases, housing adjustments are not subsidised. The Government has launched the “Building Maintenance Grant Scheme for Elderly Owners” (BMGS) in 2008 to provide financial assistance of a maximum grant of HK$40,000 for each eligible elderly owner-occupier to repair and maintain building safety of their residential flat and/or building common areas. It includes structural aspects, safety of external elevations, defective windows, fire safety, sanitary services, waterproofing membranes, cubicles, slopes, and retaining walls (The Hong Kong Housing Society, 2020).

References:

The Hong Kong Housing Society. Elderly Resources Centre & Website. Retrieved from https://www.hkhs.com/en/our-business/elderly-housing/elderly-resources-centre

For Hospital Authority (HA) patients, all medications including anti-dementia special drugs are subsidised and provided at standard fees and charges. On one hand, non-HA patients can purchase these drugs with a prescription from community pharmacies as self-financed items (The Government of the Hong Kong SAR, 2015, February 25). On the other hand, recipients of Comprehensive Social Security Assistance, Old Age Living Allowance, medical fee waiver holders, or Level 0 Voucher holders of the Pilot Scheme on Residential Care Service Voucher for the Elderly, are waived from payment for public healthcare expenses (Hospital Authority, 2018).

References:

Hospital Authority. (2018). Waiving Mechanism of Public Hospitals.

The Government of the Hong Kong SAR. (2015, February 25). LCQ17: Dementia [Press release]. Retrieved from https://www.info.gov.hk/gia/general/201502/25/P201502250512.htm

Yes, including Cognitive Stimulation Therapy. A local study (Wong et al., 2018) has provided preliminary evidence supporting its effectiveness for cognitive improvement. For the types of non-pharmacological intervention, please refer to 07.02.01.08.

 References:

Wong, G. H., Yek, O. P., Zhang, A. Y., Lum, T. Y., & Spector, A. J. I. j. o. g. p. (2018). Cultural adaptation of cognitive stimulation therapy (CST) for Chinese people with dementia: multicentre pilot study. 33(6), 841-848. https://doi.org/10.1002/gps.4663

The rapid development of innovative technologies in recent decades plays a role in enhancing elderly care services as well as dementia care in Hong Kong. The use of GPS-watch or smart phone APPs are common practices among some older people and family members for position tracking or medication reminding in daily life. More than that, many community and residential care service units for elderly have installed some systems or devices to ensure the safety of service users, such as anti-wandering, fall prevention and out-of-bed detections.

In recently years, the Government is introducing more information technology and Gerontech products with reference to other countries to enhance the quality of life of service users and to reduce pressure among care staff and family carers. The Government and Hong Kong Council of Social Service have started to organise the “Gerontech and Innovation Expo cum Summit (GIES)” since 2017, which aims to provide an international platform for stakeholders to engage in the development of gerontechnology for the ageing population in Hong Kong (The Gerontech and Innovation Expo cum Summit, 2020). Besides, the Government has earmarked HK$1 billion for the “Innovation and Technology Fund for Application in Elderly and Rehabilitation Care” (I&T Fund) in 2018 (Social Welfare Department, 2020d). The first round has been approved to subsidise more than HK$37 million to 210 elderly and rehabilitation service units to purchase or rent a total of 870 technology products, such as electric nursing beds, lifting and transfer machine “SASUKE Robohelper”, rehab training manipulator “HandyRehab”, interactive robot “UNAZUKI KABOCHAN”, multi-sensory emotion comforting pillow “inmuRELAX”, VR bicycle machine, and face recognition technology APP for pain assessment (HKET, 2020, January 8; Hong Kong Council of Social Service, 2019; Job Market, 2020, February 28). Some more examples of using technology in dementia care are described as follows:

Care-on-Call services

Senior Citizen Home Safety Association provides 24-hour care-on-call service to older people including people with dementia. It uses mobile positioning technology to locate the users and family members can check their locations easily via the “e-See Find” App by smart phone. The users can also seek help from passers-by using a remote-control ringer. This helps the users to forward phone calls to families and friends. Besides, it can regularly remind the users for outpatient appointments and provide useful information when needed (Senior Citizen Home Safety Association, 2019).

Anti-wandering vests

One of the main NGOs, Tung Wah Group of Hospitals, has developed anti-wandering vests with GPS positioning device for older people with dementia at risk of wandering. The organisation has provided the vests to Day Care Centres, District Elderly Community Centres, and Specialised Services Units for Dementia Care to prevent the loss of wandering elders (Tung Wah Group of Hospitals, 2017).

Smart shoes

Electrical and Mechanical Services Department and Hong Kong Productivity Council have produced 100 smart shoes using an RFID tag for indoors and GPS tracking system for outdoors. They were distributed to elderly centres for trial with a successful result that allows family members to easily check the location of elders through an online platform to ensure their safety (Electrical and Mechanical Services Department, 2018).

Caring Communities for Dementia Campaign

One of the dementia care units, the Jockey Club Centre for Positive Ageing, has launched the Jockey Club Caring Communities for Dementia Campaign to increase public awareness on wandering behaviour of demented elders. It has developed a smart phone APP with GPS tracking device to shorten the searching time for wandering elders by involving people in the community to provide assistance (Jockey Club Centre for Positive Ageing, 2020a).

References:

Electrical and Mechanical Services Department. (2018). Shoes that Track the Aged.

HKET. (2020, January 8). News Report (樂齡創科基金首批批出3700萬元 院舍申購訓練護理器材減員工壓力).

Hong Kong Council of Social Service. (2019). SCENARIO ISSUE 66 (NOV 2019).

Job Market. (2020, February 28). Cover Story (減輕護理員壓力 加強專業培訓 樂齡基金十億資助添器材).

Jockey Club Centre for Positive Ageing. (2020a). Jockey Club Caring Communities for Dementia Campaign.

Senior Citizen Home Safety Association. (2019). Care-on-Call Service.

Social Welfare Department. (2020d). Innovation and Technology Fund for Application in Elderly and Rehabilitation Care.

The Gerontech and Innovation Expo cum Summit. (2020). Gerontech and Innovation Expo cum Summit (GIES).

Tung Wah Group of Hospitals. (2017). 2016-2017 Annual Report.

There is currently no information about the costs of the four major anti-dementia medications in Hong Kong.

About elderly care, there are two types of informal care workers in Hong Kong, namely, foreign domestic helper and local domestic helper. They are fundamentally different in terms of their employment condition and identity in Hong Kong.

Foreign domestic helpers are the main type of informal care workers in Hong Kong since the policy of their admission in 1973. They are full-time workers, and they must live in the employers’ households. Until the end of 2018, there were 386,075 foreign domestic helpers in Hong Kong, comprising 5.2% of the population as well as 9.7% of the labour force (Census and Statistics Department, 2019j). In 2016, among the households having older adults aged 60 and over, 9% of them hired a foreign domestic helper (Legislative Council Secretariat, 2017). Among the households consisting of older adults aged 65 and over only, 13.2% hired a foreign domestic helper (39,609 out of 300,906 households) (Census and Statistics Department, 2018a).

Comparatively, local domestic helpers are much less common and their involvement in taking care of older adults is believed to be relatively small. They are usually local citizens, mainly females, who wish to have a part-time job and are hired on an hourly basis. Statistics about the number of local domestic helpers and their characteristics are very limited. According to a household survey conducted by the Census in 2000, among the households hiring domestic helper(s), while 87.9% hired foreign domestic helpers, only 12.1% hired local helpers. This constituted 1.2% of the total number of households only (Census and Statistics Department, 2001; Legislative Council Secretariat, 2017). No further information or more updated statistics regarding number of local domestic helpers are available.

References:

Census and Statistics Department. (2001). Thematic Household Survey Report No. 5. Hong Kong: Census and Statistics Department, HKSAR. Retrieved from https://www.statistics.gov.hk/pub/B11302052001XXXXB0100.pdf

Census and Statistics Department. (2018a). 2016 Population By-census: Thematic Report : Older Persons. Hong Kong: Census and Statistics Department, HKSAR. Retrieved from https://www.bycensus2016.gov.hk/data/16BC_Older_persons_report.pdf

Census and Statistics Department. (2019j). Women and Men in Hong Kong – Key Statistics 2019 Edition. Hong Kong Retrieved from https://www.statistics.gov.hk/pub/B11303032019AN19B0100.pdf

Legislative Council Secretariat. (2017). Research Brief Issue No. 4 2016 – 2017: Foreign domestic helpers and evolving care duties in Hong Kong. . Hong Kong: Legislative Council Secretariat, HKSAR Retrieved from https://www.legco.gov.hk/research-publications/english/1617rb04-foreign-domestic-helpers-and-evolving-care-duties-in-hong-kong-20170720-e.pdf.

Local studies on dementia care usually collect information about the use of domestic helpers (informal care worker) in the household of the people with dementia. Findings from several local studies are identified and summarised below. The proportion of people with dementia receiving care from informal care worker ranges between 26 – 54%.

Yan & Kwok (2011)

Sample: 122 family carers of PwD

Source of participants: District community centres

% hiring an informal care worker: 38%

Chau et al. (2012)

Sample: 300 older adults with both functional and cognitive impairments

Source of participants: Public hospitals, district community centres and day care centres

% hiring an informal care worker: 48%

Kwok et al. (2013)

Sample: 37 family carers of PwD

Source of participants: Memory clinic and hotline services of dementia service centre

% hiring an informal care worker: 54%

Cheng et al. (2013b)

Sample: 142 family carers of PwD

Source of participants: Clinics, social service agencies, and community-dwelling

% hiring an informal care worker :older adults with diagnosis but not known to service 26%

Wong & Shi, 2020

Sample: 1385 dyads of PwDs and family carers

Source of participants: Dementia Community Support Scheme

% hiring an informal care worker: 32%

In view of the significant role of foreign domestic helpers in informal care for older adults, the Social Welfare Department of the Government has implemented the ‘Pilot Scheme on Training for Foreign Domestic Helpers in Elderly Care’ to strengthen the caregiving skills of foreign domestic helpers. The training has started in September 2019 and is delivered by nurses, dieticians, physiotherapists, and occupational therapists from the Department of Health. It consists of 12 core modules on common topics about elderly care and care skills, and 4 elective modules on dementia and stroke. For dementia, the topics are ‘meal arrangements for elderly persons with dementia’, ‘communicating with the elderly persons with dementia’, and ‘managing behavioural and psychological symptoms of dementia’. The course is fully subsidised and aims to train 950 foreign domestic helpers (Social Welfare Department, 2020h).

References:

Chau, P. H., Woo, J., Kwok, T., Chan, F., Hui, E., & Chan, K. C. (2012). Usage of community services and domestic helpers predicted institutionalization of elders having functional or cognitive impairments: A 12-month longitudinal study in Hong Kong. Journal of the American Medical Directors Association, 13(2), 169-175.

Cheng, S. T., Lam, L. C. W., Kwok, T., Ng, N. S. S., & Fung, A. W. T. (2013b). The social networks of Hong Kong Chinese family caregivers of Alzheimer’s disease: Correlates with positive gains and burden. Gerontologist, 53(6), 998-1008.

Kwok, T., Wong, B., Ip, I., Chui, K., Young, D., & Ho, F. (2013). Telephone-delivered psychoeducational intervention for Hong Kong Chinese dementia caregivers: a single-blinded randomized controlled trial. Clinical interventions in aging, 8, 1191-1197. doi:http://dx.doi.org/10.2147/CIA.S48264

Social Welfare Department. (2020h, 19 May 2020). Pilot Scheme on Training for Foreign Domestic Helpers in Elderly Care. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_psfdh/

Wong, G. H.-Y., & Shi, C. (2020). Evaluation Study of the Dementia Community Support Scheme. Unpublished Manuscript. Department of Social Work and Social Adminstration. The Universtiy of Hong Kong. Hong Kong.

Yan, E., & Kwok, T. (2011). Abuse of older Chinese with dementia by family caregivers: an inquiry into the role of caregiver burden. International Journal Of Geriatric Psychiatry, 26(5), 527-535. doi:10.1002/gps.2561

All employments in Hong Kong, including informal care workers, are regulated by the Employment Ordinance (Department of Justice, 2019a). Protection of employment, such as wage, paid leave, medical attention, maternity protection, and termination of contract, are all covered in the ordinance. The Labour Department of the Government is the unit responsible for monitoring the compliance of the Employment Ordinance.

Foreign domestic helper is a special type of employment in Hong Kong that is both regulated by the Immigration Department and Labour Department. Foreign domestic helpers must work in a full-time lived-in mode and only perform domestic duties for the employer in relation to his/her household (Imigration Department, 2019). If the employment contract is terminated or expired without renewal, they are required to return to their home country. The duration of stay under this employment is not recognised for applying for permanent residence in Hong Kong. Regarding the wage protection of foreign domestic helper, the Statutory Minimum Allowable Wage (effective from 29 September 2018) is HK$4,520 per month with food provision, or with an extra HK$1,075 per month if without food provision (HKSAR Government, 2019c).

For local domestic helpers, in addition to the protection under the Employment Ordinance, their wage is regulated by the Minimum Wage Ordinance. With effect from 1 May 2019, the Statutory Minimum Wage rate is HK$37.5 per hour (Labour Department, 2020).

References:

Department of Justice. (2019a). Cap. 57 Employment Ordinance. Hong Kong: Department of Justice, HKSAR Retrieved from https://www.elegislation.gov.hk/hk/cap57.

HKSAR Government. (2019c). Press Releases – Minimum Allowable Wage and food allowance for foreign domestic helpers to increase. Retrieved from https://www.info.gov.hk/gia/general/201809/28/P2018092800357.htm

Imigration Department. (2019). Employment Contract for a Domestic Helper Recruited from Outside Hong Kong. Hong Kong: Imigration Department, HKSAR Retrieved from https://www.immd.gov.hk/eng/forms/forms/id407.html.

Labour Department. (2020, 8 November 2019). Statutory Minimum Wage. Retrieved from https://www.labour.gov.hk/eng/news/mwo.htm

For foreign domestic helpers, nearly all of them are females (98.5%) (Census and Statistics Department, 2019j). In 2016, their median age was 35, with 41% aged 25-34 and 39% aged 35-44. Most of them have attained secondary school education (82%) and some have completed tertiary education (10%) (Legislative Council Secretariat, 2017). According to a local study on foreign domestic helpers taking care of people with dementia (Bai et al., 2013), among a sample of 152 domestic helpers, 53% of them are married, 34% are single, 7% are widowed and 5% are divorced/separated.

About local domestic helpers, no information about their socio-demographic information is available. But it is also believed that most of them are females.

References:

Bai, X., Kwok, T. C., Chan, N. Y., & Ho, F. K. (2013). Determinants of job satisfaction in foreign domestic helpers caring for people with dementia in Hong Kong. Health & social care in the community, 21(5), 472-479 https://doi.org/10.1111/hsc.12029

Census and Statistics Department. (2019j). Women and Men in Hong Kong – Key Statistics 2019 Edition. Hong Kong Retrieved from https://www.statistics.gov.hk/pub/B11303032019AN19B0100.pdf

Legislative Council Secretariat. (2017). Research Brief Issue No. 4 2016 – 2017: Foreign domestic helpers and evolving care duties in Hong Kong. . Hong Kong: Legislative Council Secretariat, HKSAR Retrieved from https://www.legco.gov.hk/research-publications/english/1617rb04-foreign-domestic-helpers-and-evolving-care-duties-in-hong-kong-20170720-e.pdf.

As previously mentioned, foreign domestic helpers are the major type of informal care workers. In 2018, they consisted of 5.2% of the Hong Kong population as well as 9.7% of the labour force (Census and Statistics Department, 2019j). Nevertheless, it is important to note that the admission policy of foreign domestic helpers of Hong Kong does not allow those helpers to permanently migrate to Hong Kong even if they continuously reside in Hong Kong for more than 7 years (i.e., the main eligibility criteria for the right of abode in Hong Kong). Their period of stay is always subjected to the employment contract. Regarding their home country, Philippines (54%) and Indonesia (44%) have been the major sources of supply of informal care workers. The remaining foreign domestic helpers come from India, Thailand, Sri Lanka, and Bangladesh (2%) (Legislative Council Secretariat, 2017).

References:

Census and Statistics Department. (2019j). Women and Men in Hong Kong – Key Statistics 2019 Edition. Hong Kong Retrieved from https://www.statistics.gov.hk/pub/B11303032019AN19B0100.pdf

Legislative Council Secretariat. (2017). Research Brief Issue No. 4 2016 – 2017: Foreign domestic helpers and evolving care duties in Hong Kong. . Hong Kong: Legislative Council Secretariat, HKSAR Retrieved from https://www.legco.gov.hk/research-publications/english/1617rb04-foreign-domestic-helpers-and-evolving-care-duties-in-hong-kong-20170720-e.pdf.

All foreign domestic helpers are working in a full-time mode and are living in the households of the employer. The Statutory Minimum Allowable Wage (effective from 29 September 2018) is HK$4,520 per month with food provision (HKSAR Government, 2019c).

About local domestic helpers, little is known about their socio-economic status. The Employee Retraining Board, a statutory body in Hong Kong, has issued guidelines and suggested wages for hiring local domestic helpers. The suggested rate is HK$85 – 105 per hour for ‘Escort for Out-patient visits’ and ‘Elderly Care for Elderly with self-care ability’, and HK$90 or above ‘for Elderly without self-care ability’. Each service session is suggested to last for at least 3 hours (Employee Retraining Board, 2019).

References:

Employee Retraining Board. (2019). Reference Wages of Smart Helpers. . Hong Kong: Employee Retraining Board, HKSAR Retrieved from https://www.erb.org/smartliving/download/suggested_wages_en.pdf.

HKSAR Government. (2019c, 28 September 2018). Press Releases – Minimum Allowable Wage and food allowance for foreign domestic helpers to increase. Retrieved from https://www.info.gov.hk/gia/general/201809/28/P2018092800357.htm

Please refer to the information provided under 08.01.05. No further information is available.

Carer allowance is available for low-income family carers taking care of older adults in Hong Kong since 2014 (Social Welfare Department, 2019, January 28). Carers of people with dementia can apply for it if they meet the following criteria. The three major eligibility criteria are:

1. the older adult needs long-term care service (i.e., previously assessed as moderately or severely impaired),
2. the carer is from a low-income family and the household income does not exceed 75% of the Median Monthly Domestic Household Income,
3. the carer is providing at least 80 hours of caregiving work per month (Social Welfare Department, 2019, January 28).

For more details, please refer to Part 9.

All employments in Hong Kong are regulated by the Employment Ordinance (Cap 57). Yet, there is no policy or guideline regarding paid or unpaid leaves for personal or family matters. Family carers of people with dementia can benefit from a wide range of tax reduction measures, although these measures are not designed specifically for dementia.

References:

Social Welfare Department. (2019, January 28). Pilot Scheme on Living Allowance for Carers of Elderly Persons from Low-income Families Phase III.

Under the carer allowance scheme in Hong Kong, low-income family carers will receive HK$2,400 per month to supplement their living expenses.

Carer training programmes and support services, such as counselling services, mutual support groups and group-based psychosocial interventions are widely available in Hong Kong and are provided by all publicly funded community care service units operated by NGOs including elderly community centres, day care centres, and home care teams. Home care teams even provide on-site training at the carer’s home when necessary. Furthermore, since the implementation of the carer allowance scheme, the coverage of carer training programmes, and the support services have been further broadened, social workers at elderly community centres (i.e., District Elderly Community Centres) can reach more carers in need. Although these training programmes are not necessarily dementia-specific, dementia is a common and recurrent training topic.

In addition, the dementia-specific carer training programme is delivered under the territory-wide Dementia Community Support Scheme. One of the core services of the scheme is the “provision of training and support services to the carers on stress management and counselling services, knowledge of taking care of elderly people with dementia, formation of carer support groups, etc. with a view to alleviating carers’ burden” (Food and Health Bureau, 2019a). For more details about Dementia Community Support Scheme, please refer to Part 7.

Apart from the social care service units, the healthcare sector is also providing carer training and support. Under the Department of Health, Visit Health Teams are providing territory-wide out-reaching services in the community to provide health promotion activities for the elderly and their carers in order to increase their health awareness and the self-care ability of the elderly, and to enhance the quality of caregiving (Department of Health, 2019a). And under the Hospital Authority, a website “SmartElders” (https://www21.ha.org.hk/smartpatient/SmartElders/zh-HK/Welcome/) was established to provide useful online resources for both the older adults and their carers.

References:

Department of Health. (2019a, 1 October 2019). Elderly Heatlh Service. Retrieved from https://www.dh.gov.hk/english/main/main_ehs/main_ehs.html

Food and Health Bureau. (2019a, 4 June, 2019). Dementia Community Support Scheme. Retrieved from https://www.fhb.gov.hk/en/press_and_publications/otherinfo/180500_dcss/dcss_index.html

Three types of publicly-funded respite services are available in Hong Kong, including 1) day respite, 2) residential respite, and 3) home respite/elderly sitting. Day respite service is provided by subsidised day care units for the elderly (Social Welfare Department, 2020, May 20) where residential respite service is provided by residential care homes (Social Welfare Department, 2020, May 21). These respite services are subsidised and provided with an affordable price. Until the end of May 2020, there are a total of 189 subsidised day respite and 283 subsidised residential respite places. Home respite/elderly sitting services are provided by home care teams. Information about its availability and usage is not available.

References:

Social Welfare Department. (2020, May 20). Day Respite Service for Elderly Persons. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_csselderly/id_dayrespite/

Social Welfare Department. (2020, May 21). Residential Respite Service for the Elderly. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_elderly/sub_residentia/id_respiteser/

When carers have some enquires on legal matters such as applying for guardianship, drafting a will or advance directive, they can seek for informational support and service referrals at the LTC or healthcare service unit they visited (e.g., District Elderly Community Centre, Specialist Outpatient Clinic).

Resources for carers are also available at a local website designed for caregivers of people with dementia (https://www.adcarer.com/eng/course1_future.php) set up by the Jockey Club for Positive Ageing.

Taking care of aged parents is still a social norm of family care in Hong Kong. In general, it can be observed that the traditional Confucian notion of filial piety as a cultural norm still runs deep even in this modern and highly developed city. This provides adults children a motivation to embark on the caregiving journey. Yet, two local studies (Lee, 2004; Wong & Chau, 2006) describe and articulate that the filial values in the context of elderly care in Hong Kong are different and evolving from the traditional ones. Other than filial values, the provision of care by an adult child is also determined by their living arrangements, geographical proximity, and quality of relationship with the aged parent. It turns out that daughter usually becomes the carer, instead of the eldest son who is supposed to have the largest responsibility to take care of parents according to the traditional filial values (Lee, 2004). Moreover, carers have adopted some aspects of the filial norm, but not all of it, to suit their own experiences and actual circumstances in their everyday caregiving practices. For instance, instead of blindly following the wish of their parents, carers would challenge their parents while having their own considerations and making decisions during care provision (Wong & Chau, 2006).

In Hong Kong, when an older adult becomes in need of care, either his/her spouse or at least one of the adult children, if any, would take up the role of primary carer. Owing to the limited size of residence, adult children often live in another household nearby, instead of living with the parents in need. Moreover, live-in foreign domestic helpers and formal community care services are often utilised to assist in household chores and daily care. Regarding gender roles, females are more likely to be family carers. A recent study conducted by the author research team in 2018 to evaluate the Dementia Community Support Scheme (Wong & Shi, 2020) provides some demographic information of family carers of people with dementia in the community. Among 1385 primary carers, 66% are females, 27% are spouse of the person with dementia, 65% are children and 4% are children-in-law. In line with other local studies on family care, daughter is the most common type of family carer in terms of relationship.

Despite the family values and beliefs that maintain the provision of family care, it is important to note that the family structure in Hong Kong is changing. Due to the decreasing marriage rate and fertility rate, Hong Kong will inevitably face the challenge of reduced capacity of family in the provision of elderly care. In other words, the number of older adults without support from younger family members are expected to increase in the future. In fact, such a trend is already observed from the recent statistics on living arrangements provided by the Census (Census and Statistics Department, 2018b). From 2006 to 2016, the proportion of older adults living alone increased from 11.6% to 13.1%, those living with spouse only increased from 21.2% to 25.2%; and the proportion of households with older adults only hiring domestics helpers increased from 7.1% to 13.2%.

References:

Census and Statistics Department. (2018b). Hong Kong 2016 Population By-census – Thematic Report: Older Persons. Hong Kong Retrieved from https://www.bycensus2016.gov.hk/data/16BC_Older_persons_report.pdf

Lee, W. K.-m. (2004). Living arrangements and informal support for the elderly: Alteration to intergenerational relationships in Hong Kong. Journal of Intergenerational Relationships, 2(2), 27-49. https://doi.org/10.1300/J194v02n02_03

Wong, G. H.-Y., & Shi, C. (2020). Evaluation Study of the Dementia Community Support Scheme. Unpublished Manuscript. Department of Social Work and Social Adminstration. The Universtiy of Hong Kong. Hong Kong.

Wong, O., & Chau, B. (2006). The evolving role of filial piety in eldercare in Hong Kong. Asian Journal of Social Science, 34(4), 600-617. https://doi.org/10.1163/156853106778917790

Local studies on family caregivers which can be found under ‘Part 10: Dementia Research’ are reviewed and discussed here. Among 33 local studies included, a wide range of domains of mental health of caregivers have been studied, including care burden (16 studies), depression/depressive symptoms (14 studies), distress caused by behavioural and psychological symptoms of dementia (4 studies), role overload (3 studies), caregiving strain (1 study), burnout (1 study), anticipatory grief (2 studies), positive aspects of caregiving (4 studies), quality of life (3 studies), life satisfaction (2 studies), meaning in life (1 study), psychological wellbeing (1 study), and overall wellbeing (1 study). However, only 1 study reports the physical health of caregivers. Descriptive statistics of care burden, depression/depressive symptoms, positive aspects of caregiving, quality of life and physical health of caregivers reported by some local studies were extracted and summarised. For care burden measured by the 22-item Zarit Burden Interview, its mean ranged from 24.4 to 43.6 (total sample size: 850), indicating a mild to moderate level of burden; for depression/depressive symptoms measured by the 20-item Center for Epidemiologic Studies Depression scale, the mean score ranged from 12.9 to 19.6 (total sample size: 1468), with a score of 16 or above suggesting significant or mild depressive symptomatology.

Table 8.4. Care burden, depression / depressive symptoms, positive aspects of caregiving, quality of life and physical health of family carers of people with dementia

Note:

1. For each measure, name of the instrument, number of items and possible range are presented.
2. For clinical trials, baseline scores of each group are presented.

References:

Au, A. (2015). Developing volunteer-assisted behavioral activation teleprograms to meet the needs of Chinese dementia caregivers. Clinical Gerontologist, 38(3), 190-202.

Au, A., Lau, K., Koo, S., Cheung, G., Pan, P., & Wong, M. (2009). The Effects of Informal Social Support on Depressive Symptoms and Life Satisfaction in Dementia Caregivers in Hong Kong. Hong Kong Journal of Psychiatry, 19(2).

Au, A., Wong, M., Leung, L., Leung, P., & Wong, A. (2014). Telephone-assisted pleasant-event scheduling to enhance well-being of caregivers of people with dementia: a randomised controlled trial. Hong Kong Medical Journal, 20(3 Suppl 3), 30-33.

Chan, W. C. H., Wong, B., Kwok, T., & Ho, F. (2017). Assessing grief of family caregivers of people with dementia: validation of the Chinese version of the Marwit–Meuser caregiver grief inventory. Health & social work, 42(3), 151-158.

Cheng, S. T., Fung, H. H., Chan, W. C., & Lam, L. C. W. (2016). Short-term effects of a gain-focused reappraisal intervention for dementia caregivers: a double-blind cluster-randomized controlled trial. The American Journal of Geriatric Psychiatry, 24(9), 740-750.

Cheng, S. T., Ip, I. N., & Kwok, T. (2013). Caregiver forgiveness is associated with less burden and potentially harmful behaviors. Aging Ment Health, 17(8), 930-934. doi:10.1080/13607863.2013.791662

Cheng, S. T., Lam, L. C., & Kwok, T. (2013). Neuropsychiatric symptom clusters of Alzheimer disease in Hong Kong Chinese: correlates with caregiver burden and depression. Am J Geriatr Psychiatry, 21(10), 1029-1037. doi:10.1016/j.jagp.2013.01.041

Cheng, S. T., Lam, L. C., Kwok, T., Ng, N. S., & Fung, A. W. (2013a). Self-efficacy is associated with less burden and more gains from behavioral problems of Alzheimer’s disease in Hong Kong Chinese caregivers. Gerontologist, 53(1), 71-80. doi:10.1093/geront/gns062

Cheung, K. S. L., Lau, B. H. P., Wong, P. W. C., Leung, A. Y. M., Lou, V. W. Q., Chan, G. M. Y., & Schulz, R. (2015). Multicomponent intervention on enhancing dementia caregiver well‐being and reducing behavioral problems among Hong Kong Chinese: A translational study based on REACH II. International Journal Of Geriatric Psychiatry, 30(5), 460-469.

Chien, W. T., & Lee, I. Y. (2011). Randomized controlled trial of a dementia care programme for families of home‐resided older people with dementia. Journal of advanced nursing, 67(4), 774-787.

Fung, W.-Y., & Chien, W.-T. (2002). The effectiveness of a mutual support group for family caregivers of a relative with dementia. Archives of psychiatric nursing, 16(3), 134-144.

Lau, B. H. P., & Cheng, C. (2017). Gratitude and coping among familial caregivers of persons with dementia. Aging & Mental Health, 21(4), 445-453.

Lau, B. H. P., Lou, V. W. Q., & Cheung, K. S. L. (2018). Exemplary Care among Chinese Dementia Familial Caregivers. Paper presented at the Healthcare.

Lou, V. W. Q., Kwan, C. W., Chong, M. L. A., & Chi, I. (2015). Associations between secondary caregivers’ supportive behavior and psychological distress of primary spousal caregivers of cognitively intact and impaired elders. Gerontologist, 55(4), 584-594.

Lou, V. W. Q., Lau, B. H. P., & Cheung, K. S. L. (2015). Positive aspects of caregiving (PAC): Scale validation among Chinese dementia caregivers (CG). Archives of Gerontology and Geriatrics, 60(2), 299-306.

Tang, J. Y., Ho, A. H., Luo, H., Wong, G. H., Lau, B. H., Lum, T. Y., & Cheung, K. S. (2016). Validating a Cantonese short version of the Zarit Burden Interview (CZBI-Short) for dementia caregivers. Aging Ment Health, 20(9), 996-1001. doi:10.1080/13607863.2015.1047323

Wong, C. S. C. (2018). Mediating effects of caregiver expressed emotion on health outcomes of caregivers for patients with dementia. (Doctor of Psychology), Alliant International University, Hong Kong.

Wong, P. K., Cheung, G., Fung, R., Koo, S., Sit, E., Pun, S. H., & Au, A. (2008). Patient and Caregiver Characteristics Associated with Depression in Dementia Caregivers. Journal Of Psychology In Chinese Societies, 9(2).

Yu, D. S. F., Kwok, T., Choy, J., & Kavanagh, D. J. (2016). Measuring the expressed emotion in Chinese family caregivers of persons with dementia: Validation of a Chinese version of the Family Attitude Scale. International journal of nursing studies, 55, 50-59.

No information available. We do not know how, if any, the provision of care to people with dementia impacts the employment conditions and education opportunities of family carers.

No information available.

No.

Mostly on mental health.

The key providers of family carer support are Department of Social Welfare, NGO-operated community care service units, Department of Health, and Hospital Authority.

Yes, but there are no local studies so far exploring carers’ use of social media or other technologies in their care provision.

Social media acts as a channel for disseminating dementia-related information and articles to caregivers. Four dementia-related pages established by local parties are identified on Facebook:

1. Hong Kong Alzheimer’s Disease Association;
2. St. James’ Settlement;
3. Big Silver;
4. Community self-initiated.

Technology also allows caregivers to form virtual groups easily and support each other. It has been commonly observed that caregivers would form group chats via instant messaging tools (e.g., WhatsApp) (Christian Family Service Centre, 2016). And two dementia caregiver groups are identified on Facebook. Moreover, a local NGO, the Hong Kong Sheng Kung Hui Welfare Council Limited, has developed a mobile application ‘Act of Love. Trace Me’ to search for missing people with dementia and to provide support to their families. Through this application, information of the missing person will be posted on a Facebook page. The application is available for both iOS and Android system.

For more information on the use of GPS tracking and other technologies in dementia care, please refer to Part 7.

References:

Christian Family Service Centre. (2016, 22 January 2016). Corporate Communications – Media Coverage: Primelink Press Con – Wenweipo. Retrieved from https://www.cfsc.org.hk/en/whatsNew/detail/1071

Old age grants and disability grants, namely Old Age Allowance and Disability Allowance respectively, are available in Hong Kong and cover people with dementia. Older adults aged 70 and over in Hong Kong are eligible for Old Age Allowance. Those with more financial difficulties may apply for the means-tested Old Age Living Allowance or the Comprehensive Social Security Allowance Scheme (Social Welfare Department, 2019, July 30; 2019, September 6). People with dementia who are severely disabled, regardless of their age and financial situation, are eligible for Disability Allowance. Please refer to ‘Part 1, Social Protection’ for further information on the eligibility and cash amount of various social protection schemes in Hong Kong.

About pensions, the Hong Kong Government has implemented the Mandatory Provident Fund (MPF) scheme from 2000 to provide retirement protection. It is a mandatory, privately managed, and fully funded contribution system. Under this scheme, employers and employees are required to make regular mandatory contributions calculated at 5% of the employee’s income, subjected to the relevant income levels (Mandatory Provident Fund Schemes Authority, 2019, April 1). For employees with monthly income over HK$30,000, the monthly contributions by both employers and employees are capped at HK$1,500. Besides mandatory contributions, employees are encouraged to make voluntary contributions and enjoy tax deductions. Same as any employees, people with dementia and their carers are covered by the MPF scheme. However, there are no additional benefits in relation to dementia.

References:

Mandatory Provident Fund Schemes Authority. (2019, April 1). Contributions. Retrieved from http://www.mpfa.org.hk/eng/mpf_system/system_features/contributions/index.jsp

Social Welfare Department. (2019, July 30). Comprehensive Social Security Assistance (CSSA) Scheme. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_socsecu/sub_comprehens/

Social Welfare Department. (2019, September 6). Social Security Allowance (SSA) Scheme. Retrieved from https://www.swd.gov.hk/en/index/site_pubsvc/page_socsecu/sub_ssallowance/

There is no dementia-specific policy to provide employment protection for people with dementia. Yet, if people with dementia are in the workplace, they will be protected in the same way as everyone does in the society by the Employment Ordinance (Cap 57) (Department of Justice, 2019a) and the Disability Discrimination Ordinance (Cap 487) (Department of Justice, 2015). It is unlawful for an employer to discriminate against a job applicant or an employee with any disabilities or illness (Equal Opportunities Commission, n.d.).

References:

Department of Justice. (2015). Cap. 487 Disability Discrimination Ordinance. Hong Kong Retrieved from https://www.elegislation.gov.hk/hk/cap487.

Department of Justice. (2019a). Cap. 57 Employment Ordinance. Hong Kong: Department of Justice, HKSAR Retrieved from https://www.elegislation.gov.hk/hk/cap57.

Equal Opportunities Commission. (n.d.). The Disability Discrimination Ordinance and I.

Carer allowance is available for family carers taking care of older adults in Hong Kong since the Government launched “Pilot Scheme on Living Allowance for Carers of Elderly persons for Low-income Families” in 2014 (Social Welfare Department, 2019, January 28). The three major eligibility criteria for the scheme are, i) the older adult needs long-term care service (i.e., previously assessed as moderately or severely impaired), ii) the carer is from a low-income family, whose household income does not exceed 75% of the Median Monthly Domestic Household Income, and iii) the carer is providing at least 80 hours of caregiving work per month. Up to September 2020, three phases of the pilot scheme have been rolled out and altogether benefited approximately 6,000 family carers. Eligible carers would receive a monthly cash allowance of HK$2,400, regular carer support service provided by social worker, and recommendations of carer training programme according to their caregiving needs (Social Welfare Department, 2019, January 28).

References:

Social Welfare Department. (2019, January 28). Pilot Scheme on Living Allowance for Carers of Elderly Persons from Low-income Families Phase III.

People with dementia are under the protection of Employment Ordinance (Cap 57) like the others to enjoy the rest days, holidays with paid leave including sick leave and annual leave (Department of Justice, 2019a). Although there is no stipulation on unpaid leave under the Employment Ordinance (Cap 57), employees can discuss with their employers to take unpaid leave due to illness. No special arrangement for dementia or other illness on the leave arrangement is found.

For carers of people with dementia, there is no legal obligation for employers to offer special leave arrangements due to illness of family members or other family reasons. In most cases, carers must apply for annual leave (i.e., paid leave) if they have to accompany the person with dementia or to handle other urgent family matters. If carers have used up their entitled annual leaves, they may need to apply for unpaid leave after discussing with their employers. Some enterprises in Hong Kong offer paid personal, caretaking and/or compassionate leaves to their employees. Yet, there is no statistics about the prevalence of such leave arrangement and its coverage.

References:

Department of Justice. (2019a). Cap. 57 Employment Ordinance. Hong Kong: Department of Justice, HKSAR Retrieved from https://www.elegislation.gov.hk/hk/cap57.

There is no social insurance in Hong Kong. Hong Kong people rely on public services and voluntary purchase of health insurance products offered by private companies for medical expenses. In recent years, the Government is providing incentives to encourage voluntary purchase of health insurance product. For more details refer to Part 2: Health System Financing. Nevertheless, there are no benefits/discounts specifically offered to people with dementia.

Salaries Tax and its various types of allowance and deductions are discussed here. Again, there are no dementia-specific tax reduction measures in Hong Kong. People with dementia and their carers benefit from these current measures, but they do not enjoy extra benefits.

People with dementia who are employed and whose income are taxable, can claim the Personal Disability Allowance if they are eligible for the Disability Allowance under the Social Security Allowance Scheme (HKSAR Government, 2020, February).

Carers or family members of people with dementia can claim Dependent Parent and Dependent Grandparent Allowance if their dependent parents and/or grandparents aged over 55 are eligible for Disability Allowance (HKSAR Government, 2020, February). If the dependent is aged below 55 and is eligible for Disability Allowance, for instance, with very early onset dementia, carers can claim Disabled Dependant Allowance (HKSAR Government, 2020, February). For people with dementia living in residential care homes, their carers can apply for Deduction for Elderly Residential Care Expenses if they pay for the care home expenses (HKSAR Government, 2019, May-a). The amount of Tax Allowances and Deductions in relation to elderly care is summarised below (Inland Revenue Department, 2020, April):

Allowances

• Basic Allowance HK$132,000
• Dependent Parent and Dependent Grandparent Allowance (For each dependant)
  • Parent / grandparent aged 60 or above or is eligible to claim an allowance under the Government’s Disability Allowance Scheme HK$50,000
  • Parent / grandparent aged 55 or above but below 60 HK$25,000
• Personal Disability Allowance HK$75,000
• Disabled Dependant Allowance (For each dependant) HK$75,000

Deductions – Maximum Limits

• Elderly Residential Care Expenses HK$100,000

References:

HKSAR Government. (2019, May-a). Deduction for Elderly Residential Care Expenses. Retrieved from https://www.gov.hk/en/residents/taxes/salaries/allowances/deductions/elderly.htm

HKSAR Government. (2020, February). Allowances. Retrieved from https://www.gov.hk/en/residents/taxes/salaries/allowances/allowances/allowances.htm#pda

Inland Revenue Department. (2020, April). Allowances, Deductions and Tax Rate Table.  Retrieved from https://www.ird.gov.hk/eng/pdf/pam61e.pdf.

Not applicable as there is no valued-added tax or other type of consumption tax in Hong Kong.

In Hong Kong, most people with dementia will be benefited from the Government Public Transport Fare Concession Scheme for the Elderly and Eligible Persons with Disabilities. Under this scheme, 1) older adults aged 65 and over, 2) recipients under Comprehensive Social Security Assistance Scheme aged below 65 with 100% disabilities, and 3) recipients of Disability Allowance aged below 65, can travel on designated public transports such as train, bus, and minibus at a concessionary fare HK$2 per trip (Labour and Welfare Bureau, 2020, March 31).

References:

Labour and Welfare Bureau. (2020, March 31). Government Public Transport Fare Concession Scheme for the Elderly and Eligible Persons with Disabilities. Retrieved from https://www.lwb.gov.hk/en/highlights/fare_concession/index.html

No free or discounted companion fares in Hong Kong. Carers must pay the standard fare when they accompany the people with dementia on public transport.

Not applicable.

No. The most relevant document is the Mental Health Review Report published by the Food and Health Bureau (2017a) in 2017 that aims at making recommendations for mental health policy. In one of the main chapters about dementia, the need to invest in research for assessing the effectiveness of prevention programmes, strategies on dementia care, interventions and knowledge transfer, have been raised. The need for regular territory-wide prevalence studies of dementia to inform service planning has been emphasised and listed as one of the 10 recommendations for dementia. Yet, there is still no detailed government plan or programme for dementia-specific research.

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

There is no governmental funding allocated specifically for dementia research in Hong Kong. Yet, the Government has been funding dementia research through various schemes to support researchers from different disciplines. The TIP-CARD research team has conducted a quick online scan to search for research projects in relation to dementia funded by the Government so far. We investigated the funding records of the major governmental funding bodies with the following inclusion criteria: dementia, Alzheimer’s disease and/or mild cognitive impairment in project title. Up to the end of 2019, a total amount of HKD 201,105,938 has been offered to 163 research projects in relation to dementia, Alzheimer’s disease and/or mild cognitive impairment, through 20 different schemes under 4 governmental funding bodies including The Research Grants Council (RGC), Food and Health Bureau (FHB), Policy Innovation and Co-ordination Office (PICO), and Innovation and Technology Fund (ITF). The number of dementia projects funded per year shows an overall increase from 1 project in 2001 to 23 projects in 2019.

The number of funded projects and amount of funding in relation to dementia are categorised by their field of study. Two-third of the funded projects are in the field of biology and medicine, accounting for 77.4% of the total amount of funding. This indicates that basic sciences and medicine continue to be the dominating subject areas for fund allocation. While nearly one-third of the funded projects are in the field of humanities and social sciences, only 16.6% of funds are offered to these projects. Twenty out of the 46 funded projects in humanities in social sciences focus on caregivers or both caregivers and the PwD, while only one study in biology and medicine mentions caregivers in the project title. It is also observed that these projects seldom address the economic aspect of dementia.

No. Research development in Hong Kong is mainly directed by the Government, funders, care professionals, and research professionals. In the area of dementia research, there is no information showing that the persons with dementia are involved in this process.

Besides government funding, there are two philanthropic organisations constantly funding dementia research in Hong Kong: The Elderly Fund under Simon KY Lee Foundation and the Hong Kong Jockey Club Charities Trust.

Under Simon KY Lee Foundation, the Simon K. Y. Lee Elderly Fund was set up in 2007 with a mission to improve the well-being and quality of life of the elderly. It supports pioneering projects in areas of elderly care that are in critical need yet not well funded, seeking to address the problems via collaboration with the social welfare sector and the academia (Simon K.Y.Lee Foundation, 2020). This fund has committed itself to the area of dementia care and promotion of “Early Detection and Early Intervention”. Since 2008, it has funded a total amount of HK$20.9 millions to support research, service, and capacity building for academic institutions and NGOs.

The Hong Kong Jockey Club is a pioneer in caring for persons with dementia. In 2000, it established the Jockey Club Centre for Positive Ageing, Hong Kong’s first dementia care centre integrating research, training, and service. In 2006, The Hong Kong Jockey Club Charities Trust donated HK$380 millions and launched the project CADENZA: A Jockey Club Initiative for Seniors which aims at nurturing academic leaders in gerontology and shaping the attitudes of the general public through a range of training and public education programmes. This initiative has sponsored a wide range of research activities and social care service in relation to dementia throughout the years.  A one-stop integrated health and social care centre, the Jockey Club CADENZA Hub was under this initiative as well and it set up in 2011 (The Hong Kong Jockey Club, 2013).

References:

Simon K.Y.Lee Foundation. (2020). Elderly Projects.

The Hong Kong Jockey Club. (2013). Jockey Club funds Hong Kong’s first-ever mobile health checks for dementia.

The HKU COA JMK Dementia Care Scholarships have been supported younger researchers interested in the area of dementia since 2013. In 2013, the Sau Po Centre on Ageing of The University of Hong Kong Centre received a donation of HK$1 million from Mr. Joe Ma and Dr. Karen Cheung to support the academic initiatives on dementia care with an aim to raise public awareness and care to dementia patients, their families and caregivers. Under this donation, the scholarships scheme was established to support dementia research conducted by research postgraduate students in the Faculty of Social Sciences of The University of Hong Kong. The awardees would receive an amount of HK$10,000 per person to support their studies. Since 2013/2014, a total of 7 research postgraduate students have been supported by this scholarships scheme.

There is no published scoping review of dementia research in Hong Kong at this moment. Yet, the TIP-CARD research team has conducted a scoping review on the non-medical literature through systematically searching “Hong Kong” and “dementia/Alzheimer’s Disease/cognitive impairment” in three databases: Medline, PsycInfo and PubMed. There is no restriction on the year of publication during the search. Initially, 1656 non-duplicated articles have been identified. After reviewing by two independent researchers in the team, 285 empirical studies published between 1991 and June 2019 are included in this review. These studies are categorized into the following 8 themes:

1. Interventions for PwD or PwCI: 68 studies
   • More than half of the intervention studies aims at improving the cognitive functioning and memory of the participants, and 10 studies have focused on Behavioural and Psychological Symptoms of Dementia (BPSD) (mainly agitation).
   • Improvement in IADL, falling, mood, social interaction, pain management, diabetic control, sleep quality, psychomotor speed has also gained some attention.
   • The influence of Chinese culture has been widely observed in the use of intervention: there are 9 Tai-Chi, 7 acupuncture, 4 mah-jong, 3 calligraphy, 2 Chinese Chan, and 1 Six Arts intervention studies. The effectiveness of music-with-movement intervention, Cognitive Stimulation Therapy, and various cognitive training interventions have also been examined.
2. Instruments for screening/assessing patient and caregiver: 56 studies

• There are 9 studies developing instruments for caregiver’s burden, management strategy, expressed emotion, grief, and positive aspects of caregiving.
• 47 studies are validating instruments for older adults with cognitive impairment. Most of them are screening tools for dementia /cognitive impairment, and assessment for memory and cognitive decline. A few are examining BPSD, awareness of memory deficits, dementia psychosocial care quality, executive function and testing new means of assessment.

3. Caregiver status and caregiving experience: 49 studies

• There are 30 quantitative studies and 19 qualitative studies, including 14 intervention studies improving caregiver outcomes.
• A wide range of topics are observed, including caregiver well-being, caregiver burden, education and training, coping and management strategy, attitudes towards persons with dementia and decision making, social support, abuse, positive meaning finding, self-efficacy, gratitude, anticipatory grief, expressed emotion, and life satisfaction.

4. Health & functional performance: 48 studies
   • These 48 studies describe: 1) the clinical profile of the population with neuropsychiatric symptoms, 2) physical status such as eye movement, oral health, hearing impairment, late-life body mass index; 3) activity status like physical activities, sedentary behaviour, getting lost; 4) psychosocial status including emotional reactions, loneliness, subjective complaints, 5) capacity to make decisions on treatment, financial issues; and 6) care needs and service use.
5. Associated factors for cognitive health: 37 studies
   • Four groups of factors for cognitive health have been examined in Hong Kong population: 1) physiological factors: frailty, widened pulse pressure, poor balance, diabetes; 2) neurocognitive and psychosocial factors: semantic fluency, neuropsychiatric symptoms, depression, distress, self-esteem, anxiety, quality of life; 3) demographic factors: education, gender, subjective social status; and 4) lifestyle: nutrition, dietary, spiritual activity, physical exercise, leisure activity.
6. Service providers’ attitudes and capacity: 12 studies

• There are studies examining service providers’ knowledge, attitudes towards disease and persons with dementia, as well as how they practice and manage care services.
• The job and life satisfaction of paid carers have also been discussed.
• Physicians, nurses, nursing assistants and other healthcare workers in both healthcare and long-term care system have been mentioned.
• Two educational interventions on service providers have been evaluated.

7. Prevalence of dementia: 8 studies
   • There are 5 studies reporting estimates on prevalence of dementia in Hong Kong.
   • Regarding different types or stages of dementia, 1 study reported on the prevalence of very mild and mild dementia, 1 on cognitive impairment, and 1 on dementia with Lewy Bodies.
8. Awareness and attitudes towards dementia: 7 studies

• There are 7 studies describing and investigating the attitudes, awareness and experience about dementia and its care of the persons with dementia as well as the general public.

Hong Kong has some but not sufficient information to assess the performance of the care systems for people living with dementia.

On one hand, the Hospital Authority keeps regular records of death rates and life year lost due to dementia, as well as co-morbidities and medication profile of patients. The Financial Secretary regularly provides some reliable estimates for health care cost and LTC cost (though not all dementia-specific). Moreover, the Social Welfare Department and Hospital Authority are good sources for understanding available dementia service.

On the other hand, there is no up-to-date and regular monitoring mechanism for the followings: prevalence (the latest was in 2005), incidence, quality of life of people with dementia or carer, LTC cost with breakdowns of dementia service, service types, availability and care cost by the private LTC sector, prevalence of receipt and provision of unpaid care, and size and breakdown of dementia workforce (both healthcare and LTC).

There is currently no dementia-specific policy and plan in Hong Kong. Although the Government acknowledged the need to set out a dementia-specific policy and engaged a wide range of stakeholders in the review of dementia care and elderly service, the role and responsibilities of these stakeholders in the way onward were never clearly spelled out. In addition, there is no recognised/official dementia-specific government unit nor representative who is responsible for the formulation of dementia policy.

Prevention, early detection, diagnostic service by primary care, case management, care co-ordination in community, flexible/ tailored respite service, training of formal care workforce, informal carer training, and public education of end-of-life care and related legal matters are the major service provision gaps in Hong Kong.

Further studies are needed in Hong Kong to ascertain the prevalence, incidence, societal cost, quality of life of people with dementia, size and impact on informal carers, and capacity of formal dementia workforce. These findings will help to understand the disease burden of dementia as well as the capacity of Hong Kong to better inform the development of a dementia-specific policy and plan.