1. The Search for a Holistic Care Model for Supporting Elderly People: The Case of Hong Kong Professor Nelson W S Chow Department of Social Work and Social Administration The University of Hong Kong

2. Western Findings on Supporting the Elderly The needs of the elderly may be physical, social or psychological in nature and their satisfaction involves the contributions of different professions. The State has the primary responsibility, at least in terms of planning, in supporting the elderly, though the role of the family and the community cannot be neglected.

3. Western Findings on Supporting the Elderly (II) Institutional care provides a most comprehensive form of support for the elderly, though home-based/community care can be considered as an alternative. Community care often implies family care or women care. A public policy to support the elderly is based on a concept of the right of every individual to living in dignity.

4. Features of Support System for the Elderly in East Asian Societies The family remains the primary support system for the elderly. Home-based care (or community care) is seen as the most desirable form of care: a detest or a resistance for institutional care.

5. Features of Support System for the Elderly in East Asian Societies (II) Support efforts must give due respect to the traditional role and status of the elderly. The source of help makes a difference to the elderly in need of care – best coming from children, followed by other family members, friends and outsiders.

6. Stages of Development of Support System for the Elderly in East Asian Societies Stage 1: Elderly people in need of care receive support entirely from their families, relatives or friends. Stage 2: Care institutions, homes and centers for elderly people are established by private or charitable organizations as an alternative, and often an inferior one, to family care.

7. Stages of Development of Support Systems for the Elderly in East Asian Societies (II) Stage 3: Public services for needy elderly are seen as necessary supplements to family care – A rapid development of public financial and care provisions. Stage 4: The search for an integrated model and a mix of different public, private and family efforts in enhancing the quality of life of the elderly.

8. Development of Support for the Elderly The Case of Hong Kong Stage 1 (End of WWII - 1965): The care of the elderly was entirely the responsibility of the family. Stage 2 (1965 – 1973): Institutions began to be set up by charitable and religious organizations to take care of the elderly who were lonely or their families were unable to support them.

9. Development of Support for the Elderly The Case of Hong Kong (II) Stage 3 (1973 – 1994) – The “Care in the Community” approach adopted and began the provision of public services to supplement family and community efforts in supporting the elderly. Stage 4 (1994 – now) – The principles of “Ageing in Place” and “Continuum of Care” adopted in an effort to combine the contributions of the formal and the informal sectors in meeting the needs of the elderly.

10. The Sharing of Roles in Supporting the Elderly in Hong Kong Families in Hong Kong are still playing the major role in supporting the elderly – 1.6 million adults (out of a population of 7 million) are financially supporting their parents. Public provisions, including health care, social security, housing and welfare, together form the safety-net for needy elderly – HK SAR Government is annually spending HK$40 billion (about 20% of total Government budget) on various public services for the elderly.

11. The Sharing of Roles in Supporting the Elderly in Hong Kong (II) Individuals are saving for their retirement with the introduction of the Mandatory Provident Fund in 2001 – 5% each of salary from both employee and employer. Fee-paying institutions and services for elderly people begin to appear as alternatives to public provisions.

12. The Sharing of Roles in Supporting the Elderly – A Dynamic Process Family support is predicted to decrease from around 55% of total resources to 10% Self support is predicted to increase from 22% to 65% Public support is predicted to increase from 23% to 25% 0 50 100 2005 (%) 2035 Family Self Public

13. Conceptualizing a Holistic Care Model for the Elderly Objective – It is a care model aiming at helping the elderly requiring care in a comprehensive manner – a combination of institutional and home-based care. Underlying Values – A holistic care model considers all the care needs, physical, social and psychological, of the elderly in an attempt to improve their entire quality of life.

14. Conceptualizing a Holistic Care Model for the Elderly (II) Stakeholders – The model recognizes that the meeting of the care needs of the elderly must be the result of the combined efforts of all parties, including the government, the community, the family, and the elderly themselves, with each supplementing and complementing one another. Delivery System – The delivery system under the holistic care model is a seamless system crossing over both institutional and home- based services.

15. A Holistic Care Model for the Elderly – A Mix of East & West Ideals It is a model that takes into consideration all the research findings in the West regarding the needs of the elderly and finds ways to enhance their overall quality of life. It is a model that particularly suits the special circumstances of East Asian societies where the family and the community are still playing an important role in caring the elderly.

16. A Holistic Care Model for the Elderly – A Mix of East & West Ideals (II) It provides a chance for every party to play its role and represents the best way to deploy and utilize available resources, as well as not to over-burden any party. It concurs with values held dear in East Asian societies where elderly people feel most happy and dignified when they are treasured and loved by their families.

17. Conceptualizing the Holistic Care Model for the Elderly Values – Improving entire quality of life of the Elderly Delivery – A seamless system crossing over institutional and home- based services Objective – Meeting comprehensively all care needs of the elderly