Re-engineering Community Support Services for Elders

1. Re-engineering Community Support Servicesfor Elders Mrs Carrie Lam Director of Social Welfare 28 August 2002

2. Purpose • To introduce the Re-engineering Framework and Working Parameters • To invite eligible NGOs to participate in the Re-engineering • To appeal to NGOs for understanding and support to make the Re-engineering a success despite the constraints

3. Background

4. A SWOT Analysis in Support of the Re-engineering Strength • Policy consensus emerging from the 2000 Consultancy Study • High level endorsement, namely Elderly Commission and LegCo Welfare Panel • An environment more conducive to change • LSG becoming mainstream subvention • Enhanced DSWO role in district planning and co-ordination

5. A SWOT Analysis in Support of the Re-engineering (cont’d) Strength(cont’d) • An environment more conducive to change (cont’d) • Fiscal stringency pushing greater drive for cost-effectiveness • Service rationalisation and integration in family and youth services • Successful experience gained through the 15 new integrated projects with 35 NGOs taking part in the quality-based allocation process

6. A SWOT Analysis in Support of the Re-engineering (cont’d) Weakness • Fiscal stringency – no earmarked additional funding dedicated to re-engineering • Adverse employment situation, hence greater need to safeguard jobs and honour obligations to existing staff • Adverse emotional reactions from end users - the elders – if not managed carefully • A very complicated scene and heterogeneous group of operators – big and small NGOs which affect their capability to re-engineer (81 NGOs operating 35 M/Es and 213 S/Es)

7. A SWOT Analysis in Support of the Re-engineering (cont’d) Opportunity • Putting in effect the desired integrated service mode on a much larger scale • Addressing problems in the existing system as highlighted in Consultancy Study • Laying a service infrastructure to meet growing and changing needs of elder – current generation and next

8. A SWOT Analysis in Support of the Re-engineering (cont’d) Opportunity (cont’d) • Creating room for further service integration beyond elderly welfare services e.g. between elderly and family, between health and welfare • Opening up opportunity for greater use of information technology • Demonstrating further collaboration and partnership between SWD and NGOs

9. A SWOT Analysis in Support of the Re-engineering (cont’d) Threat • Community Chest’s funding reduction would directly hamper the continued operation of some M/Es and S/Es • Inability to meet challenges from an ageing population

10. Guiding Principles Adopted by SWD in Developing the Re-engineering Parameters • Simplicity, clarity and certainty • Participation is entirely voluntary • Bottom-up, instead of top-down • Focus on district and service user needs, no disruption to existing service users as far as possible • Driven by co-operation and mutual understanding, rather than competition • No staff redundancy

11. General Parameters forthe Re-engineering • No price bidding and minimal competition amongst NGOs • In-situ expansion and/or upgrading of services • Subvention and not time-defined • Eligibility: • NGOs opted/will opt for LSG in 2003-04; • open to Chest and non-Chest members; • small NGOs to form consortium under one principal agency

12. General Parameters (cont’d) • Quality proposal: to demonstrate the agency’s vision, synergy of resources and value-added services. No vigorous vetting of proposal • No moving goal posts: service details, output and outcome indicators and funding level follow closely to those new integrated elderly projects commissioned • NGOs are expected to take care of their respective catchment needs as far as possible

13. Scope of Re-engineering Centre-based • Multi-service Centres for the Elderly (M/Es) to District Elderly Community Centres (DECCs) • Social Centres for the Elderly (S/Es) to Neighbourhood Elderly Centres (NECs)

14. Scope of Re-engineering (cont’d) Home-based • Home Help (HH), Home Care (HC) & Meal Teams (MT) to Integrated Home Care Services Teams (IHCSTs) • upgraded to take care of elders of moderate to severe level of impairment (frail cases) • expanded to serve more elders with no to mild impairment (ordinary cases) • existing HC and MS teams will be disbanded upon contract expiry by end March 2003

15. Philosophy and Values • Community-based integrated services • Partnership and co-operation • Caring community • Healthy ageing and empowerment • Family responsibility • Client-focused care • Innovation • Effectiveness and efficiency

16. I. Re-engineering of Centre-based Services

17. Objective of DECC and NEC • DECC: Provides a full range of efficient and quality support services in in integrated manner to healthy, vulnerable and frail elders living in the community and family carers. • NEC: Serves as a neighbourhood base for community network of informal support and formal social services provided to the elders and the community at large.

18. Costing and parameters • Reference cost– (by referring to Shan King DECC, Fu Tai NEC & Tin Yuet NEC) DECC: $3.50 Mn NEC : $1.18 Mn • Existing subventions– M/E : $2.91 Mn S/E : $0.72 Mn

19. Cost of Transformation • M/E to DECC: $0.59 Mn ($3.50 Mn - $2.91 Mn) • S/E to NEC: $0.46 Mn ($1.18 Mn - $0.72 Mn) • The cost will be met by: • pooling of existing subventions by NGOs through rationalisation/closure of existing S/Es or deletion of posts in other elderly day services with good justification; and • additional resources injected from SWD

20. Transformation Formula (on an agency basis)

21. Prescribed Minimum Requirement of Pooled Resources for Transformation $ 0.18 million for each S/E to NEC and M/E to DECC transformation This may come from: • closure of S/E ($0.72 million per centre, partial savings not acceptable) • rationalisation/EPP in other elderly community services (partial savings in terms of subvented posts acceptable, to be calculated on LSG basis, i.e. salary mid-point + 6.8% PF)

22. Consequential Arrangements Upon transformation DECC NEC Provision to meet PF requirement and TOG of “snapshot” staff will likewise be granted on 100% basis 100% subvented

23. Alternative Usage of the Closed Centre • Return to the landlord (SWD, GPA, HD) • NGOs are welcome to operate elderly-related services at no cost to SWD • Subject to proven need, SWD is prepared to meet the rent and rates of the premises • Priority will be given to usages that promote self-help and organisations by elders themselves

24. Analysis of NGOs Operating S/Es 79 NGOs (213 S/Es) 71 LSG (198 S/Es) 8 non-LSG (15 S/Es) 16 operate M/E and S/E (80 S/Es) 55 operate only S/E (118 S/Es) 5 non-Chest member (9 S/Es) 3 Chest member (6 S/Es) 26 operating >1 S/E (89 S/Es) 29 operating only 1 S/E (29 S/Es) 17 non-Chest member (17 S/Es) 12 Chest member (12 S/Es)

25. Assistance to Small NGOs • For single-service NGOs operating S/E only who are Chest members and unable to pool resources to join the re-engineering exercise, SWD would • Revert to the Chest for possible assistance • In case of failing a positive response from Chest, may consider picking up the 20% funding deficit for such S/Es to stay put as S/Es.

26. II. Re-engineering of Home-based Services

27. Objectives • The upgraded home help teams will be renamed as “Integrated Home Care Services Teams” (綜合家居照顧服務隊) • They should enable individuals, including elders, disabled and needy families to • Stay in the community • Achieve and maintain an optimal level of functioning and independence • Acquire the necessary skills to adapt to changing health status

28. Objectives (cont’d) • Service operators are expected to meet increasing demand within existing resources as far as possible (as in the case of HHT at present serving an average of over 110 cases as opposed to 60 in the FSA) • We welcome agencies’ innovation in further re-engineering their respective upgraded teams on a district basis

29. Catchment Area & Allocation of Additional Cases and Resources (1) • 9 districts with HC and MS (25 teams): • Islands (1 team) • Southern (2 teams) • Sham Shui Po & Kowloon City (4 teams) • Kwun Tong & Sai Kung (4 teams) • Wong Tai Sin (3 teams) • Kwai Tsing & Tsuen Wan (4 teams) • Yuen Long (2 teams) • Tai Po & North (2 teams) • Sha Tin (3 teams)

30. Catchment Area & Allocation of Additional Cases and Resources (2) • Service Operators will take up cases now served by HC and MT contracts through: (a) upgrading: to serve cases suffering from moderate to severe level of impairment or disability (frail cases); (b) in-situ expansion: to serve cases from no to mild level of impairment or disability (ordinary cases)

31. Catchment Area & Allocation of Additional Cases and Resources (3) • Allocation of cases will be made on an agency basis and district basis • Allocation of frail cases will be made on blocks of ten places each • Allocation of ordinary cases will be made with reference to the proportion of frail cases taken up by each agency within the district

32. Catchment Area & Allocation of Additional Cases and Resources (4) • Maximum cases to be allocated within each district is pre-set taking account of resource availability and projected number of cases served by existing HC and MT contractors

33. For Districts without HCTs & MTs • 4 districts without HCTs & MTs • Central & Western • Eastern & Wan Chai • Yau Tsim Mong • Tuen Mun • Allocation on basis of 5 districts (Eastern and Wan Chai as two separate districts) • Only frail cases to be allocated. Allocation of cases similar, i.e. on an agency and district basis

34. Admission into Service • For elderly cases at moderate and severe level of impairment/disability, service users referred to Operators in accordance with the 18 District Council districts by SCNAMO(ES)s • For ordinary cases, existing HC and MT service users referred to Operators according to service boundaries of HCTs & MTs. Operators may directly admit new users • Re-defining the service boundaries may be required in consultation with DSWOs to allow flexibility

35. Cost Provision • Unit cost for cases of moderate or severe level of impairment/disability: $3,382 per month • Unit cost for ordinary cases: $500 per month

36. Hypothetical Re-engineering Plan (1) Existing service provision Agency currently operates 4 M/Es, 8 S/Es and 8 HHTs in the following 6 districts

37. Hypothetical Re-engineering Plan (2) Centre-based service (1) • The 3 S/Es in Kwun Tong, Sai Kung and Sha Tin districts will be closed having regard to adequate coverage by other NGOs in the district. • All the 4 M/Es and the remaining 5 S/Es will be upgraded to DECCs and NECs respectively.

38. Hypothetical Re-engineering Plan (3) Centre-based service (2)

39. Hypothetical Re-engineering Plan (4) • Home-based service (1) • Agency proposes to upgrade all its 8 HHTs in Eastern, Kwai Tsing and Tsuen Wan districts to IHCSTs. • Agency applies for a total of 80 frail cases in these districts:

40. Hypothetical Re-engineering Plan (5) Assuming the Agency’s application is fully accepted, allocation of cases and additional resources to the Agency will be:

41. Hypothetical Re-engineering Plan (6) Summary of Agency’s outcome of re-engineering: • Operates 4 DECCs in three districts supported by Agency’s own NECs (5) and other NGOs’ NECs in the district • Upgrade all 8 HHTs into IHCSTs serving ordinary and frail cases • Receive total additional subvention of $5.71 million a year ($2.16 Mn + $3.55 Mn under HHT upgrading) • Propose to retain/swap S/E vacant premises to set up sub-base or elderly-related services on self-financing basis in the relevant district(s) • Ensure no staff redundancy • No longer requires to rely on Chest or raise fund to meet funding gaps in respect of its M/Es and S/Es

42. New Scene Achieved through Re-engineering Other Government offices: Housing Dept., Police, Social Security Field Units Residential care services for elders: RCHE, respite, dementia services NEC NEC NEC Educational bodies: lifelong learning institutes Home-based services for elders: Home Help Teams, Integrated Home Care Service Teams, Enhanced Home and Community Care Services DECC NEC NEC NEC Specialised services: Elder abuse prevention, elder suicide prevention Medical and health services: Elderly Health Centres, hospitals and clinics

43. A New District-based Planning Mechanism Achieved through Re-engineering District Planning District Social Welfare Office DECC DECC DECC NEC NEC NEC HH NEC DE NEC IHCS NEC NEC NEC NEC IHCS IHCS DE HH NEC NEC Sub-district Coordination Sub-district Coordination Sub-district Coordination

44. Implementation Schedule (1)

45. Implementation Schedule (2)

46. Thank you