Abstract

Objectives: The long term care (LTC) system in Hong Kong is largely a tax-based system, with funding provided by the government while services provided by NGOs. Although the government has adopted “aging in place” as its policy objective for LTC since the 1970s, a great majority of LTC funding goes to residential care. The demand for LTC has exceeded the capacity of services providers and there is a long waiting list for services. To cut down the waiting list and to prepare Hong Kong for population aging, we initiated a project to develop a new long term care infrastructure for the city. The objectives of this project include (1) to update the existing LTC assessment instrument to make it more sensitive for services matching and (2) to develop a case mix system based on the resource utilization groups for LTC. The project was implemented between 2013 and 2017.

Methods: We adopted the interRAI-LTCF and HC instruments and translated them to Chinese and culturally adapted them to Hong Kong. Using these instruments, we collected longitudinal assessment data (three assessments per person) from 1,044 nursing home residents and 598 community care services users. We also conducted a staff time measurement (STM) to collect services use data from them. In the STM for nursing homes, we collected total minutes of care for each care activity over 24 hours and for seven consecutive days. The seven day STM data were later converted to monthly data for easy comparison. For each care activity, we also collected the type and number of staff involved. For community care, we collected the STM data for a month from the billing records of the services providers, including both the types of services, staff involved, and total minutes.

Results: The median care time for nursing home residents was 10,300 minutes per month. Among them, 12% were professional care time (e.g. nursing care time) while 88% were supportive care time (e.g. bathing care). The median care time for community care was 966 minutes, among them, 13% were professional care time and 87% were supportive care time. Based on the assessment and STM data, we developed seven case mix groups: reduced physical functions, behavioral problems, impaired cognition, clinically complex, special care, extensive care, and special rehabilitation. We also calculated the median care time associated with each case mix group. Finally, based on the case mix groups and the associated care time, we developed a services matching formulate to better match the needs of frail elders to the most appropriate services.

Conclusion: The STM data and the assessment data together allow us to develop a case mix system based on the clinical profiles of local elders. The government has already adopted the new instruments as the standardized assessment instrument for LTC in Hong Kong. The new case mix system will allow better allocation of limited LTC resources based on clinical profiles of frail elders, instead of allocating these LTC resources based on the existing first come first serve principle.