Residential service for Ageing ID Workshop for 29

Residential service for Ageing ID Workshop for 29 June 2009 Yeung tak wah

• What is the current situation? • Is this situation meet the needs of Ageing ID? • What are views of government, parents Ageing Person with MH? • What are views form international experts? Where are we heading?

The current situation in HK • 1. Currently we have a total no. of 32, 284 Persons with ID in our Central Registration for the Disabled. • 2. Male : 19, 195 Female: 13, 089.

Age Profile • 1. age Male • 0_5 149 • 6— 11 1192 • 12– 14 853 • 15— 19 1683 • 20— 29 5997 Female 76 523 472 1528 3249

Age profile continue • • • age Male 30— 39 4332 40– 49 2958 50 ---59 1536 60 ---64 270 65 and above 220 Female 3354 2548 1448 171 208

• Age 60 and above %: 2. 6% • Age 50 and above %: 12% • In view of 20 year later: % soar up.

Longevity • UK: Currently 12% of ID population aged >65 by 2040 expect it to be 25% (UK) (7) • 2% of population > 65 will have ID • 1063 people with ID >55 years in NZ in 1993 (Hand 1995): numbers increasing • In 2003 half IHC users in Central Region >55 (8)

What does this mean? • We are going into an ageing ear. • The ID/MH population also follows this trend. • What is our policy responding to such a trend?

Current policy • The policy objective of the Government in respect of the provision of residential services aims at providing appropriate residential care and necessary training and support services for those persons with disabilities who cannot live independently and those who cannot be adequately cared for by their families, with a view to improving their quality of life and helping them develop independent living skills.

Types of service providing • Residential Services Hostel for Severely Mentally Handicapped Persons (HSMH) Hostel for Moderately Mentally Handicapped Persons (HMMH) Hostel for Severely Physically Handicapped Persons (HSPH) Care & Attention Home for the Aged Blind (C&A /AB) Care & Attention Home for Severely Disabled Persons (C&A /SD) Small Group Home for Mildly Mentally Handicapped Children (SGH – MMHC) Supported Hostel (SHOS)

Adult Services Day Activity Centre (DAC) Sheltered Workshop (SW) Supported Employment (SE) Integrated Vocational Rehabilitation Services Centre (IVRSC) Integrated Vocational Training Centre (IVTC) Skills Centre (SC)

Community Services Community Rehabilitation Day Centre (CRDC) Home-based Training & Support Services (HBTS) Community Rehabilitation Network (CRN) Central Paramedical Support Service Unit (CPMS)

Elderly Services Enhanced Home & Community Care Services (EHCCS) Integrated Home Care Services (IHCS) Hostel for the Elderly Home for the Aged Care & Attention Home for the Elderly Nursing Home Private Practice

Direction • With an ageing population, the demand of persons with disabilities for residential services will increase progressively. Moreover, it is envisaged that drastic changes in social environment and increase in work pressure will also lead to a rise in the number of persons with disabilities and their demand for residential services.

• formulate long-term plan for persons with disabilities in terms of residential services and develop in a continuous manner various kinds of residential services with different levels of support to meet the needs of persons with disabilities;

• continue to strive to help persons with disabilities to live in the community and to ensure that residential services and community support services complement each other and are developed in parallel; and

• regulating hostels for persons with disabilities and promoting the parallel development of private, self-financed and subvented hostels to provide more service alternatives for persons with disabilities; • developing diverse long-term and shortterm residential services to meet the different needs of persons with disabilities;

• deploying resources for residential services so as to maintain a steady increase in the number of new residential places; • reviewing the direction of the “ageing-inplace” policy in terms of residential services;

UN International Plan of Action on Ageing • Housing for the elderly must be viewed as more than a mere shelter. In addition to the physical, it has psychological and social significance. . • Thus in developed regions this may typically involve an ordinary house or apartment in an urban setting, but some developing regions a life in a rural setting in a typical dwelling place. • Congregate care, i. e. , the grouping of a large number of people outside the expected range of people living together should be rejected, as should dwellings isolated from the main community.

A person’s home should be in a situation typical for members of the community in which the person lives or has originated from. Support in the home and community should be sensitive to the person’s level of dependency and should adjust to agerelated changes.

• The ethos of domestic settings should be one of personal choice for the resident(s). • Enriched residential settings, providing remedial or habilitative services, should permit the person to remain attached to their community and in contact with family and friends. • Old-age housing should only be used if it provides for a more enriched quality of life than the person’s normal habitat.

Rehab. Program Plan • Residential Care: while the overall direction is to encourage persons with disabilities to live in the community with their families and friends, the special needs of those persons with disabilities who cannot live independently or be adequately cared for by their families are recognised.

• The RPP recommends that the Government formulate a long-term plan, developing in a sustainable manner various kinds of residential services with different levels of support, including regulating residential services and promoting the three-pronged development of private, self-financed and subvented hostels, so as to provide more service options for persons with disabilities;

• Community Support: community support play an integral part in enabling persons with disabilities to live in the community and facilitating their full integration into the community.

• The RPP supports continuous development of such support services and recommends enhancing people-oriented services, providing more support to carers, developing community mutual help networks and rendering multi-disciplinary support services;

The Questions remain • What are programs to achieve such plan?

Views from parents with an ageing MH • To know that someone will love their child & look out for their interests • To know who to contact for help • Information and ongoing support about how to plan ahead –without the stress of dealing with a service organisation that is judgmental & unresponsive

• The opportunity to share the wealth of information they hold about their family member. For their role and knowledge to be acknowledged • “All I want is some peace of mind that he’ll be all right when I’m gone. ” • To know that the person will have a sense of belonging – a decent place to live • To be involved in planning and decision making

• Majority want to see their son/daughter develop their competencies to the highest level possible. • That their dependent will be safe and well cared for. • They want to die with their affairs in order. They want to provide a secure future for their son/daughter with a disability who survives them.

• Assurance that their family member will have support to deal with loss when they (the parents die). • to know what will happen to their dependants in a crisis. Reassurance that help will be available in a crisis • More than that their son/daughter receives a service and is financially secure.

Needs of Ageing Persons with MH • To be seen as an individual • To have someone who cares about them and what happens to them • To have their ageing seen as theirs not a groups’ • To have the whole of their life valued • For positive expectations to be held of them • To maintain important relationships, acquaintances and connections- to have people in their lives who are not paid to be there • To have a real home

QOL Domains and Indicators Domain Indicators Emotional Well-Being Contentment, Self-Concept, Freedom from Stress Interpersonal Relations Interactions, Relationships, Supports Material Well-Being Personal Development Financial Status, Employment, Housing Education, Personal Competence, Performance Physical Well-Being Health Status, Nutritional Status ADLs, Recreation Self-Determination Autonomy, Personal Goals, Choices Social Inclusion Community Access and Use, Community Roles Rights Legal and Human (Dignity and Respect)

Housing for Ageing Persons with Mildly MH • • • Married quarter. Independent and choice Relationship with relatives and others Community life Financial independence Personal competence enhancement

Housing for ageing persons with Moderate MH • • • Personal goals Interrelationship with others Overall performance in group living Self concept Community roles

Housing for ageing persons with severe MH • • • Freedom from stress Supports Health care issues Dignity and respect recreation

Practical support to sustain current relationship between parent and family member • Most parent-carers want to continue to be involved in the life of their disabled family member for as long as possible. • With depleting levels of energy and finances practical assistance which is respectful and sensitive to the family situation is likely to be welcomed. • There is considerable agreement about what older parents would like from service providers. Walker & Walker 1998

• Greater continuity in staffing. • Safety net provision to cope with crises. • Good quality flexible services. • Services working in real partnership with families. • The parent-carer role being valued –their views being respected. • Greater preventative approach with an eye on planning for the future

Areas that will require attention • Supporting people with disabilities to fill roles in the community that will bring them recognition and value -neighbours, friends, club members, workers, rather than clients or disabled people • Development of competencies reduce level of protection required. • People with challenging behaviour are at particular risk – being isolated, rejected and brutalised

• Developing a network of supportive people can provide an important safety net around the person. Presence of committed unpaid people is critical to the person’s well being in the long term. - need to be cultivated in the present - unlikely to spontaneously appear. • Need to strengthen & expand citizen advocacy -competent citizens are recruited to develop a relationship with one vulnerable person.

acknowledgement • • • Rehabilitation program plan (HKSAR) CRASDA Statistics (HKSAR) Qo. L Robert Schalock Roy Brown Alan and Ann Walker Janica