CADENZA Symposium 2009 Primary Care and Older Persons Medical and Social Integration

1. CADENZA Symposium 2009Primary Care and Older PersonsMedical and Social Integration Dr Lam Ching-choi Haven of Hope Christian Service 6 October 2009

2. 4 Quadrants and Gaps in Medical – Social Integration Medical Social DH HA SWD NGOs • Gaps b/w medical • and social • Gaps b/w public • and private • Inefficient and • ineffective Public Fee for Service GPs Private

3. The Drivers of the 4 Quadrants Medical Social • Drivers • Reduce case load, hospitalisation • Support GPs income • Provide medical service • Have choices SWD NGOs DH HA Public (1) (3) (4) (2) Fee for Service Private GPs

4. The Ideal Model of Medical – Social Integration Provider Perspectives • Full Integration Model • Addresses the drivers of the 4 quadrants • Need of a Service Delivery model (case • management) • Need for appropriate Service Philosophy for the Delivery model • (trans-disciplinary team) • Need for a financially viable model (resource allocation; sustainable) Medical Social SWD NGOs DH HA Public (1) (3) Full Integration Model (4) (2) Fee for Service Private GPs

5. The Ideal Model of Medical – Social Integration User Perspectives • R Person centred • user choices • timely provision • need based • Promotion of self-care de-professionalisation of care • Prevention of deterioration on-going maintenance programmes

6. The Ideal Model of Medical – Social Integration Funder Perspectives • Cost effective • measurable indicators • ‘value for money’ • no duplication of funded services • Evidence based • proven interventions • Sustainable • co-payment

7. GovernmentExamples Medical Social SWD NGOs • Medical-social in Public • IDSP • CRDC • Public-Private in Medical • PPPs • Public-Private in Social • Self-financing RCHEs DH HA IDSP CRDC Public (1) (3) Full Interation Model Self Financing PPPs (2) (4) Private Fee for Service GPs Hardly any service with more than 2 quadrant involvement; Hardly any medical-social in private

8. HOHCS Examples Haven of Hope EHCCS • SWD purchases service fromHOHCS to provide social, nursing and allied health services • Somewhat public-private in social service • - HOHCS keeps surplus, if any; however, • present funding not enough, may not be • sustainable to provide appropriate level • of service • - For Funder - cost effective? no duplication • of funded service? presently, fees at • nominal, sustainable?

9. HOHCS Examples Haven of Hope EHCCS • HOHCS’ Service Delivery Model • and Service Philosophy - Strong trans- disciplinary team of allied health, nursing, social workprovides case management and case conference aiming towards client’s self-care Case Conference with Trans-disciplinary team

10. HOHCS Examples Haven of Hope EHCCS • HOHCS’ Service Delivery Model • and Service Philosophy - For Users – person centred, timely provision, need-based; carers’ involvement; promotion of self-care; prevention of deterioration

11. HOHCS Examples Haven of Hope EHCCS • Supported with purchase of service for psycho-geri • service from HA; optometry, dietetics, dental screening • from HOHCS’ units - Medical-social interface limited to psycho-geri thru’service purchase from HA - Other medical/health services supported by HOHCS - Private medical sector not involved

12. HOHCS Examples Haven of Hope DECS – satellitecentresof DECC • Accessibility for early detection • of health and social care needs, • and their prevention at local • communities of housing estates • Early and timely detection of • medical care needs from • regular health check and • available health consultations

13. HOHCS Examples Haven of Hope DECS – satellitecentresof DECC • Simple rehab for a fee • for HA discharged • patients • Isolated singletons have • more social interactions when • health needs are addressed

14. HOHCS Examples Haven of Hope DECS – satellitecentresof DECC • Development ofa network • of ‘healthier’ older persons • caring their weaker • members

15. HOHCS Examples Haven of Hope DECS – satellitecentresof DECC • - HOHCS initiative of using medical and social • integration • Essentially an earlydetection primary care service • - No particular funding from government for service • No recognition of chronic healthcare needs at • service

16. HOHCS Examples Healthy City, CHDs & Clinics • OutreachingMedicine services to residential homes • and social centres Western Medicine Chinese Medicine

17. HOHCS Examples Healthy City, CHDs & Clinics • Collaborations - CGAT stable HT and diabetes • patients for medical care in clinics and lifestyle • classes and support

18. HOHCS Examples Healthy City, CHDs & Clinics • Community building and large scale wellness promoting • and early detection programmes using social work • approaches Awareness, Prevention and Early detection of Cognitive impairment (APEC) project Falls prevention (Carers training )

19. HOHCS Examples Healthy City, CHDs & Clinics • HOHCS initiative of private, public, medical and • social integration • Healthy City – District Council & HOHCS funding • CHDs – Jockey Club & Comm Chest & HOHCS • Clinics – self-financing • Essentially an earlydetection, health promotion • primary care service • - No particular funding from government

20. The Ideal Model of Medical – Social Integration Obstacles & Hindrances • Lack of full and formal recognition by Govt on health elements in elderly social centres • - manpower • - space • Lack of full and formal recognition on the social • determinants of wellness and well-being in • primary health services • ‘All or nothing’ financing arrangements hindering public-private interface

21. The Ideal Model of Medical – Social Integration Proposed Service • Characteristics of the Service • timely and ready care and a supportive network of professionals, family members, fellow sufferers and volunteers • facilitates and supports self-care in the long run • reduces the progression and complications of the chronic disease(s) • delays onset of other non-communicable diseases

22. The Ideal Model of Medical – Social Integration Proposed Service • Service Infrastructure • A coordinating centre/team • A network of services that include all the • elements of primary care, including medical, • nursing, allied health and social services to serve • targetted older persons with targetted services • A funding mechanism that involves private • medical practitioners and co-payment • 4.An interfacing platform for information flow

23. CADENZA Symposium 2009Primary Care and Older PersonsMedical and Social Integration Dr Lam Ching-choi Haven of Hope Christian Service 6 October 2009 End of Presentation Thank You