Residential service for Ageing ID

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Residential service for Ageing ID

• Workshop for 29 June 2009
• Yeung tak wah

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• 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?

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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.

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Age Profile

• 1. age Male Female
• 0_5 149 76
• 611 1192 523
• 12 14 853 472
• 1519 1683 1528
• 2029 5997 3249

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Age profile continue

• age Male Female
• 3039 4332 3354
• 40 49 2958 2548
• 50---59 1536 1448
• 60---64 270 171
• 65 and above 220 208

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• Age 60 and above 2.6
• Age 50 and above 12
• In view of 20 year later soar up.

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Longevity

• UK Currently 12 of ID population aged gt65 by
  2040 expect it to be 25 (UK) (7)
• 2 of population gt 65 will have ID
• 1063 people with ID gt55 years in NZ in 1993 (Hand
  1995) numbers increasing
• In 2003 half IHC users in Central Region gt55 (8)

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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?

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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.

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Types of service providing

• Residential ServicesHostel 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
  (CA /AB)Care Attention Home for Severely
  Disabled Persons (CA /SD)Small Group Home for
  Mildly Mentally Handicapped Children (SGH
  MMHC)Supported Hostel (SHOS)

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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)

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Community Services

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

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Elderly Services

• Enhanced Home Community Care Services
  (EHCCS)Integrated Home Care Services
  (IHCS)Hostel for the ElderlyHome for the
  AgedCare Attention Home for the
  ElderlyNursing HomePrivate Practice

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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.

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• 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

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• 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

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• 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 short-term
  residential services to meet the different needs
  of persons with disabilities

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• 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-in-place
  policy in terms of residential services

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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.

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• A persons 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 persons level of dependency and
  should adjust to age-related changes.

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• 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 persons normal habitat.

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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.

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• 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

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• 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.

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• 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

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The Questions remain

• What are programs to achieve such plan?

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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

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• 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 hell be
  all right when Im 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

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• 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.

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• 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.

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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

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QOL Domains and Indicators

• Domain Indicators

Emotional Well-Being
Contentment, Self-Concept, Freedom from Stress
Interpersonal Relations
Interactions, Relationships, Supports
Material Well-Being
Financial Status, Employment, Housing
Personal Development 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)
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Housing for Ageing Persons with Mildly MH

• Married quarter.
• Independent and choice
• Relationship with relatives and others
• Community life
• Financial independence
• Personal competence enhancement

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Housing for ageing persons with Moderate MH

• Personal goals
• Interrelationship with others
• Overall performance in group living
• Self concept
• Community roles

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Housing for ageing persons with severe MH

• Freedom from stress
• Supports
• Health care issues
• Dignity and respect
• recreation

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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

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• 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

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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

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• Developing a network of supportive people can
  provide an important safety net around the
  person. Presence of committed unpaid people is
  critical to the persons 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.

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acknowledgement

• Rehabilitation program plan (HKSAR)
• CRASDA Statistics (HKSAR)
• QoL Robert Schalock
• Roy Brown
• Alan and Ann Walker
• Janica