Challenges of Long Term Care Needs in the Ageing Population in Chinese Communities

1. Challenges of Long Term Care Needs in the Ageing Population in Chinese Communities Dr. Edward MF Leung President Hong Kong Association of Gerontology 15th World Congress on Long Term Care in Chinese Communities 2018 Hong Kong

2. Need of Long Term Care in Ageing Population • The Demand on Long Term Care in an ageing population • Determinants of the Needs of Long Term Care • Coping with increasing need of Long Term Care • Financing of Long Term Care

3. The rapid phase of population ageing in the chinese communities

4. 2000

5. 2000

6. 2000

7. 2000

8. 2000

9. 2025

10. 2025

11. 2025

12. 2025

13. 2025

14. 2050

15. 2050

16. 2050

17. 2050

18. 2050

19. Determinants of Long Term Care Need • Population Ageing • Incidence of disabling chronic illnesses • Functional Status of older people • Family support for older people • Community support

20. Nursing Homes Residents per 1,000 Population by Age, Sex and Race/Ethnicity, 2004 (US) Female Male Residents per 1,000 population Data Source: The National Nursing Home Survey

21. Population ageing • Distribution in age structure • Young old against old old ratio • Female outlive male

22. Disabling illnesses • Cerebrovascular diseases • Dementia • Alzheimer • Vascular dementia • Parkinsonism • Fracture • Osteoarthritis • End stage heart, chest and kidney diseases

23. Functional abilities of older people • Instrumental Activities of Daily Living • Activities of Daily Living • Mobility • Cognitive function • Feeding function • Falls • Bowel and Urinary incontinence

24. Family support of older people • Size of family • Extended family against nuclear family • Family relationship • Migration of family member from rural to urban area and from one country to another country

25. Community support • The need of formal long term care services especially Institutional Care depends much on the presence or absence of adequate community support for the older people and their family

26. Coping with increasing need of long term care • Prevention of diseases in old age • Fostering family relationship and family support • Enhancing community support services • Carer support

27. Prevention of diseases in old age • Life style modification for late adulthood • Dietary habit • Anti-smoking • Exercise • Reduction of obesity • Early detection and treatment of diseases • Hypertension and Diabetes • Prevention of accidents and falls

28. Fostering family relationship and family support • Strengthening of traditional value • Promotion of family relationship • Housing policy to enable family support of older generations • Support of family carers

29. Enhancing community support • Neighbourhood support • Day services • Home care services • Community nursing services • Respite services • Rehabilitation support • Medical care

30. Carer support • Identification of informal carers in the community • Provide training and education • Provide material support to carers • Psychosocial support to the carers • Respite care for needs of the carer

31. Ageing Impact in China

32. ADL dependence in older people in China in 2000 (%)

33. 2000-2100 Ageing Trend for≥60 (in 100 million) 4.60 (2052) 3.81 (2100)

34. 2000-2100 population trend for ≥80 (in 10,000)

35. Mode of Delivery • Balance of institutional care against community care • Innovation • Advancing technology and knowledge • Diversification of services

36. Analysis on the impact of surge in elder care to public finance of Hong Kong 1

37. Future Trend in Ageing Population 3

38. 4

39. The Need of Long Term Care 9

40. OECD country Institution Rate (2004-2008) 10

41. Macao Long Term Care Study 11

42. The Need of Long Term Care Institution in Hong Kong 12

43. Subsidized places • (e) = (c) – (d) Year 2011 2016 2021 2026 (a) Age over 65 874 634 505 505 (b) Estimated need • private homes places • (2021, 2026 – 20% market share) (c) Existing places*／projected requirement (c) = (a) x (b) 3.4% 2.9% 3.4% 3.4% 128,600 93,300 63,700 45,100 2,538 3,498 825 1,661 1,330* 2,166 3,172 4,372 Planning for Residential Care in Macao (3.4%) 13 *1330 – existing number of beds

44. How to plan for the future needs in residential care • Use existing provision by government – 2.6% • China Planning Ratio - 3.0% • Macao Planning Ratio – 3.4% • OECD Median – 4.6% • Existing Need – 5.5% 14

45. The possible supply for Residential Care Places based on different ratio of provision 15

46. The need for additional places in residential care 16

47. Additional Annual Resources in coping with the demand on residential care in 2017-18@HK$13,000 per bed/month • Existing provision percentage – 2.6% • 6,978 place, + HK$1,088,568,000 (1billion) • Total 32,903 places (HK$5,132,868,000. 5 billion) • Macao Reference rate – 3.4% • 17,102 places, + HK$2,667,912,000 (2.6billion) • Total 43,027 places (HK$6,712,212,000. 6.7 billion) • OECD Median – 4.6% – 32,288 places, + HK$5,036,928,000(5.0billion) • Total 58,213 places (HK$9,081,228,000. 9 billion) • Fulfill existing need – 5.5% • 43,677 places, HK$6,813,612,000(6.8billion) • Total 69,602 places (HK$10,857,912,000. 10 billion) 17

48. Implication to public policy on aged care • The Need to review in the provision of residential care for older people in Hong Kong • Importance of providing alternative solution to institutional care to satisfy the needs and reduce the demand on institutional care • Explore the possibility of co-payment in reducing public financing burden • Introduction of means test mechanism for users of residential care 18

49. Financing of long term care • Increasing reliance of state support • Rising age dependency ratio • High cost in the provision of institutional long term care services • Unable to rely simply on a tax based system

50. Options for long term care financing • Own savings / out of pocket • Insurance - private • Insurance - with public contribution or intervention • Tax based financing • Part of Medical insurance