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

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

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

4. Public Private MedicalSocial DH HA GPs SWD NGOs Fee for Service Full Integration Model (1) (3) (2) (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)

5. The Ideal Model of Medical – Social Integration User Perspectives  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. Public Private MedicalSocial DH HA GPs PPPs SWD NGOs Fee for Service Full Interation Model Self Financing IDSP CRDC (1) (3) (2)(4) Government Examples Medical-social in Public - IDSP - CRDC Public-Private in Medical - PPPs Public-Private in Social -Self-financing RCHEs 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 from HOHCS 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 work provides case management and case conference aiming towards client’s self-care Case Conference with Trans-disciplinary team

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

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 – satellite centres of DECC Early and timely detection of medical care needs from regular health check and available health consultations Accessibility for early detection of health and social care needs, and their prevention at local communities of housing estates

13. HOHCS Examples Haven of Hope DECS – satellite centres of 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 – satellite centres of DECC Development of a network of ‘healthier’ older persons caring their weaker members

15. HOHCS Examples Haven of Hope DECS – satellite centres of DECC - HOHCS initiative of using medical and social integration - Essentially an early detection 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 Outreaching Medicine services to residential homes and social centres Western MedicineChinese 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 Falls prevention (Carers training ) Awareness, Prevention and Early detection of Cognitive impairment (APEC) project

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 early detection, health promotion primary care service - No particular funding from government

20.  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 The Ideal Model of Medical – Social Integration Obstacles & Hindrances

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 1. A coordinating centre/team 2. 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 3. A funding mechanism that involves private medical practitioners and co-payment 4. An interfacing platform for information flow

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