By Kayla Wong, Terry Lum and Gloria Wong (HKU), 27th March
In Hong Kong, because of the experience with the SARS epidemic in 2003, the Government and society responded very quickly and imposed strict policies and practice guidelines to stem the spread of virus in community and in long term care facilities. The Social Welfare Department issued its first guideline for special arrangements for subvented welfare services in response to the COVID-19 on January 28 (https://www.swd.gov.hk/en/index/site_pubpress/page_press/act_index/year_2020/). While the outbreak appeared to be under control earlier this month, a spike in cases was noted in the 23rd March week and tighter measures, such as adjustment to non-urgent services, were imposed to contain a second wave of infection. The Government announces daily updates with its public service arrangements in response to the outbreak (https://www.coronavirus.gov.hk/eng/public-services.html), including helplines for daily necessities and/or food for home confines. More details as follows:
Health Services for Older People
Non-urgent medical services, such as routine follow-up for chronic illnesses or non-urgent surgery, have been postponed starting from 29 January 2020. Family members of older patients are encouraged to pick up medications from clinics in lieu of regular follow up physician visits to reduce the risk of infection. New service arrangement of the 18 Elderly Health Centres has been announced starting from 17 February 2020.
Subsidized Community and Residential Care Services for Older People
- Residential care services: All services are provided as normal. However, visiting professional services, such as the Visiting Medical Practitioner Service or the Multi-disciplinary Outreaching Support Teams for the Elderly for Residential Care Homes are either ceased or provided on a limited scale. Some professional services, such as occupational therapy services for people with dementia, are able to delivered via IT enhanced methods. Visits by family members, friends, or community members are not allowed unless for compassionate reasons. All volunteering visits have been stopped. Some residential care facilitates use IT channels such as the Whatsapp, Facetime or Zoom to organize virtual visits by family members.
- Community care services: Day care centers for the elderly have suspended their service but remain open to serve those in special need, but at a much reduced capacity. For example, a typical day care center may have the capacity to take care of 60 older adults, but now only take care of up to 20 older adults. Elderly centers that provide active aging activities and caregiver support services are all closed to the general public, but staff continue report duty to provide urgent support services to elders or caregivers in the community. Staff call center members by phone regularly, likely weekly, to provide social and emotional supports. All essential home support services such as visiting nurse services, meal deliveries, escort to medical appointments, and medication management continue, but providers are given more flexibility on how those services are delivered. For example, re-usable containers were used in meal delivery services before the epidemic, but changed to disposable containers after the epidemic to reduce the need for cleaning. Other non-essential services, such as bathing and chore services, are either stopped or delivered in a much reduced capacity.
Guidelines for Residential Care Homes for Older People
- Residents newly discharged from hospitals: Staff are advised to pay extra attention to their personal hygiene care, health conditions and body temperature. Residents with fever or respiratory symptoms are required to wear surgical masks and are recommended to continue their existing isolating or cohorting practice.
- Travel outside Hong Kong: Residents and staff are recommended to avoid all non-essential travel and to inform the institution in advance to facilitate arrangement upon return. All people who have travelled overseas in the past 14 days are subject to compulsory quarantine for 14 days upon arrival.
- Visit arrangement: Visits (i.e., family members, friends, volunteers, etc.) are recommended to be avoided as far as possible and family members are suggested to contact residents or staff by other means (e.g., telephone and video communication).
- Activity and environment: Residents are recommended to avoid leaving their room and mixing activities with other residents, such as having meal in their room and using a designated toilet. They are advised to put on a surgical mask when need to leave the room and clear a pathway for transfer. Environmental disinfection with 1 in 49 diluted household bleach at least daily for the room and at least twice daily for frequently touched areas. Cleansing staff are advised to wear appropriate personal protective equipment.
Responses from NGOs
- Online day care: Some NGOs such as Christian Family Service Centre have started to offer remote activities and counselling through video links to older people with mild and moderate dementia. Weekly packages of interactive activities ranging from cognitive stimulation to simple arts and crafts are provided, which aim to enhance physical, mental, cognitive and self-management skills abilities during home isolation.
Video phone calls: Local telecommunications companies sponsored and partnered with some NGOs such as Evangelical Lutheran Church Social Service to provide video phone calls to replace physical visits to nursing homes, encouraging families and friends to cheer up and provide spiritual comfort for the residents.
- Special emergency support campaign: Senior Citizen Home Safety Association has launched a special campaign to provide emergency support to older people in the community. A professional team of nurses and social workers conduct risk level assessment, provide counselling and psychiatric referrals, and arrange services such as medication refills, household cleaning and hygiene supplies delivery.
- Anti-epidemic measures and financial assistance: Some NGOs, such as Tung Wah Group of Hospitals, Caritas Hong Kong and Po Leung Kuk, have been delivering surgical masks and anti-epidemic packs (e.g., food and disinfection supplies) through its service units, including deprived families and singleton older people in the community. Emergency financial support, contingency supplies and free traditional Chinese medicine treatment were also provided to diagnosed patients and their families with financial difficulties.
References from Government webpages:
Department of Health, 25 March 2020
Centre for Health Protection, 18 March 2020
Social Welfare Department, 28 February 2020
References from media:
Wong K, Lum T, Wong G (2020) Report from Hong Kong: Long-Term Care Responses to COVID-19 by Increased Use of Information and Communication Technology. LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE.