LTCcovid Country Profile – Printable Version
1.00. Brief overview of the Long-Term Care system
Long-term care is mostly provided by family and other unpaid carers, with some provision by paid carers for those who can afford it. The Government covers the costs of care for people who fit the “Three No’s” category: no ability to work, no income and no family. Relying on families as the main source of care is increasingly under question given demographic and social changes resulting in smaller and geographically dispersed families. In response to this, the government has increased its focus on developing a formal long-term care system, initially through encouraging the rapid development of a private institutional care sector, setting targets for numbers of beds. This took place before developing regulation and quality assurance mechanisms and has led to the lack of development of community-based care. There are shortages of trained care professionals. There have been pilots of social long-term care insurance in 16 cities since 2016, with strong policy interest on these as a mechanism for long-term care financing. For a good overview read Feng et al. (2020).
Update for: China Last updated: January 6th, 2022
1.14. Pandemic preparedness of the Long-term care sector
After the experience of the SARS epidemic in 2003, which resulted in the deaths of 72 care home residents, the Government published the first “Guidelines on Prevention of Communicable Diseases in Residential Care Homes for the Elderly” in 2004 and required all care home operators to designate an Infection Control Officer to coordinate and implement infection control measures (Lum et al., 2020)
References:
(2020) COVID-19 and Long-Term Care Policy for Older People in Hong Kong, Journal of Aging & Social Policy, 32:4-5, 373-379, DOI: 10.1080/08959420.2020.1773192
Update for: Hong Kong (China) Last updated: February 11th, 2022
2.00. Overview impacts of the Covid-19 pandemic on people who use and provide Long-Term Care
After a relatively successful start of the COVID-19 pandemic, it appeared that Hong Kong’s strict zero-COVID policy had succeeded in protecting the population (including people living in care homes and relying on care from others) from COVID-19. However this situation has changed during the Omicron wave (see question 2.02). Perhaps due to this early success, the vaccination rates among older people are very low, even among the care home population.
Update for: Hong Kong (China) Last updated: March 23rd, 2022
2.01. Impact of the COVID-19 pandemic on the country (total population)
As of December 2, 2021, there have been 98,897 confirmed cases of COVID-19 in China, and 4,636 deaths, according to the National Health Commission, corresponding to 0.33 attributed deaths per 100,000 population.
Update for: China Last updated: December 5th, 2021 Contributors: Disha Patel |
2.01. Impact of the COVID-19 pandemic on the country (total population)
As of April 8, 2022, more than 1.17 million people have contracted the virus since the onset of the fifth wave of COVID-19 (starting from 31 Dec 2021), involving 8,430 deaths. About 96% of the deaths were people aged 60 years and over, while over 70% are those aged 80 years and over. The latest data on the epidemic situation of the 5th wave in Hong Kong can be found on the Government’s news site.
Update for: Hong Kong (China) Last updated: April 11th, 2022 Contributors: Cheng Shi |
2.02. Deaths attributed to COVID-19 among people using long-term care
Data availability
There is no regularly published official data on the number of deaths of care home residents in Hong Kong, so this section reports data from credible media sources.
Early part of the pandemic
In Hong Kong, until 2022, the strategy of zero-COVID was successful in limiting infections in care homes. As of December 2020, there had been 20 care homes with outbreaks. This resulted in 124 residents and 29 staff members testing positive for COVID-19. Of these 124 residents, 32 had died, accounting for 19% of all COVID-19 related deaths in Hong Kong.
Omicron wave
The situation has been very different since the arrival of the Omicron wave. Since March 2022 there have been major outbreaks in care homes and large number of deaths. The media reported, on March 23 2022, that, of the just over 6000 deaths in the whole population to that date, 60% were care home residents. In addition, a total of 33,758 care home residents (45% of the total) were infected at that time in 776 care homes.
This high impact of the Omicron variant has been attributed to low vaccination rates among older people and lack of isolating facilities within care homes.
Size of care home population
In June 2020 there were 76,091 care home places in Hong Kong. Therefore, the number of deaths of care home residents linked to COVID-19 so far would represent 2.3% of this population.
Update for: Hong Kong (China) Last updated: April 11th, 2022 Contributors: Cheng Shi |
2.04. Impacts of the pandemic on access to care for people who use Long-Term Care
Non-urgent medical services (follow-up appointments for chronic illnesses, non-urgent surgery) started to be postponed in late January 2020. Family members of older people were invited to pick-up medications from clinics to reduce the risk of infection. There were also new service arrangements put in place for the ‘Elderly Health Centres’ in February 2020.
Day care services in Hong Kong have largely suspended their services but offered reduced services to people with special needs. Other community based services have been closed, but staff continue to provide urgent services and follow-up with members on regular basis to provide ‘social and emotional support’.
Domiciliary services continue. However, providers can operate with greater flexibility and non-essential services were either suspended or scaled back. For example, meal delivery services have moved to disposable containers (Source: https://ltccovid.org/wp-content/uploads/2020/07/Hong-Kong-COVID-19-Long-term-Care-situation_updates-on-8-July-1.pdf).
Update for: Hong Kong (China) Last updated: August 2nd, 2021
3.01. Brief summary of the overall pandemic response (not specific to Long-Term Care)
Following the experience with the SARS epidemic (2003), the government quickly imposed strict policies and guidelines in community and long-term care facilities. Already in late January 2020, the Social Welfare Department provided the first COVID-19 guideline ‘for special arrangements for publicly funded welfare services’. In addition to daily updates regarding its public services arrangements, the government also offers ‘helplines for daily necessities and/or food’ for people confined at home (Source: https://ltccovid.org/wp-content/uploads/2020/07/Hong-Kong-COVID-19-Long-term-Care-situation_updates-on-8-July-1.pdf).
In July 2020, with the development of a third wave, containment measures across society were escalated. This included screening and quarantine for foreign domestic workers entering Hong Kong, orderly return of travellers from higher-risk countries, mandatory COVID-19 testing and medical surveillance for crew members of aircrafts and vessels, tightening of social distancing measures, limiting of the number of people in restaurants and entertainment venues, and suspension of visits to LTC facilities, rehabilitation centres, and non-acute hospitals (Source: https://ltccovid.org/wp-content/uploads/2020/07/Hong-Kong-COVID-19-Long-term-Care-situation_updates-on-8-July-1.pdf).
Update for: Hong Kong (China) Last updated: September 8th, 2021
3.04. Financial measures to support users and providers of Long-Term Care
Some NGOs have delivered ‘surgical masks and anti-epidemic packs’, emergency financial support, contingency supplies, and Chinese medicine treatments to people in need (Source: https://ltccovid.org/wp-content/uploads/2020/07/Hong-Kong-COVID-19-Long-term-Care-situation_updates-on-8-July-1.pdf).
Update for: Hong Kong (China) Last updated: September 10th, 2021
3.06. Support for care sector staff and measures to ensure workforce availability
A survey by the Hong Kong Social Workers and Employment Union in February 2020 showed that about 10% of care workers had to take unpaid leave or experienced pay deductions. The Social Welfare Department responded with a number of measures. These measures included a special allowance for workforce support. This means that subsidised residential and domiciliary care services receive a ‘one-off special allowance for workforce support’ and to ‘maintain daily operations in the event of COVID-19 related staff absences. Costs for this measure were about 130 million Hong Kong Dollars (HKD). In addition, social care providers have received a special allowance to pay the staff in 745 subsidised homes an additional 10% of their monthly salary (capped at 4,000 HKD) for at least 4 months. The additional salary was reserved for staff working during the epidemic. The cost of this measure amounts to approximately 208 million HKD (Source: https://ltccovid.org/wp-content/uploads/2020/07/Hong-Kong-COVID-19-Long-term-Care-situation_updates-on-8-July-1.pdf).
Update for: Hong Kong (China) Last updated: September 10th, 2021
3.07. Infection Prevention and Control measures in the Long-Term Care sector: guidance, support and implementation
Early on in the pandemic care home resident were advised not to leave their rooms and to avoid contact with others. Instead they were encouraged to have their meals in their rooms and to use designated toilets. If they needed to leave the room, they were advised to wear a surgical mask. Hygiene protocols were supposed to clean the rooms on a daily basis and at least twice a day for areas that were frequently touched (https://ltccovid.org/wp-content/uploads/2020/07/Hong-Kong-COVID-19-Long-term-Care-situation_updates-on-8-July-1.pdf).
Update for: Hong Kong (China) Last updated: September 9th, 2021
3.07.03. Visiting and unpaid carer policies in care homes
During the worst period of the pandemic, all the nursing homes were in lockdown, meaning that no one was allowed in or out, including nursing home staff. Administration staff were asked to work from home or take leave. Currently, nursing homes are not completely open, but in low risk areas visitors with a prior reservation can enter upon taking a temperature test and showing a green ‘health code’. This signifies their personal epidemiological status, which is related to where they have been and who they have recently come into sustained contact with. The same regulations are in place for staff who are working there. Visits that are not family related are stricter and depend on the specific regulations in each nursing home.
In June 2021 nursing homes were open to visitors with a prior reservation. When entering a nursing home, taking a temperature check, and showing a green ‘health code’ are required. The Health code is a QR code assigned by a color-coded system to each citizen according to their personal epidemiological status, which is related to their Covid-19 test results and whether they have visited non-low risk areas or have been in contact with infected persons recently. The same regulations are in place for staff who are working there. Voluntary activities are restricted in most areas, which depend on the specific regulations in each nursing home.
Update for: China Last updated: September 8th, 2021
3.07.03. Visiting and unpaid carer policies in care homes
In the early part of the pandemic, visits of relatives and friends were suspended, ‘unless for compassionate reasons’. In some residential care settings remote/virtual meetings were organised to sustain contact with residents’ families. Visiting professional services were also delivered remotely, suspended or reduced in scale. Volunteers were not allowed to come into the homes (https://ltccovid.org/wp-content/uploads/2020/07/Hong-Kong-COVID-19-Long-term-Care-situation_updates-on-8-July-1.pdf).
As of July 2021, visiting in care homes is allowed for individuals with prior reservation who are able to show a negative test result, which has been undertaken within the last three days. For family members who have had more than two weeks since being vaccinated, they can use the result of a self-administered Covid-19 test, instead of a standard lab test result.(https://ltccovid.org/2021/08/05/current-situation-in-relation-to-visiting-in-care-homes-and-outings-for-residents-ltccovid-international-overviews-of-long-term-care-policies-and-practices-in-relation-to-covid-19/)
Update for: Hong Kong (China) Last updated: November 23rd, 2021
3.09. Access to Personal Protection Equipment (PPE) in the Long-Term Care sector
Following a survey by the Hong Kong Social Workers and Welfare Employee Union in February 2020 that showed more than one quarter of respondents did not receive adequate PPE from their organisations, the Social Welfare Department gave 3 rounds of special allowances to procure PPE and sanitising items (total costs HK$34 million) to residential care homes for older people, community care providers and others. In additional, all residential care units were informed that they would receive 1 million face masks (https://ltccovid.org/wp-content/uploads/2020/07/Hong-Kong-COVID-19-Long-term-Care-situation_updates-on-8-July-1.pdf).
Update for: Hong Kong (China) Last updated: November 9th, 2021
3.10. Use of technology to compensate for difficulties accessing in-person care and support
NGOs in Hong Kong have provided older people with tablet computers that provided them with access to home sports videos, cognitive training games and equipment to monitor their help. The system would inform relevant persons (medical teams/family) if the health monitor registered abnormality. Other NGOs offers videos for sensory stimulating activities anti-epidemic exercise or remote activities and counselling for people with mild to moderate dementia (https://ltccovid.org/wp-content/uploads/2020/07/Hong-Kong-COVID-19-Long-term-Care-situation_updates-on-8-July-1.pdf).
Update for: Hong Kong (China) Last updated: September 8th, 2021
3.11. Vaccination policies for people using and providing Long-Term Care
The Chinese Government announced that over 215.2 million people aged 60 and over have been vaccinated in mainland China by the 29th November, with the remaining 50 million (20%) older people not vaccinated. The National Health Commission of the PRC requires local authorities to promote the vaccination rate among older people based on their health conditions and provide follow-up observation service in the community-level after being vaccinated. Currently, some areas also have set up a vaccination “Green Channel” for older people or provide mobile vaccinating services (e.g., mobile medical vans) to reduce their waiting time.
In Mainland China, long-term care staff have been identified as the priority group to receive COVID-19 vaccination in national level. For now, there is no sign that Covid-19 vaccination will be mandated in law for long term care staff, however, in practice, local government and care providers have made vaccination compulsory already without passing any regulation. Care staff and care institutions have very high willingness be vaccinated.
Other vaccinations such as flu are not compulsory.
Update for: China Last updated: December 6th, 2021 Contributors: Cheng Shi |
3.11. Vaccination policies for people using and providing Long-Term Care
COVID-19 vaccine and booster doses roll-out
On the 8th April 2022, the Hong Kong Government announced that persons aged 60 or above who have received three doses vaccine may receive the fourth vaccine dose at least three months after their last dose. This additional dose is recommended for older people living in the community as well as those living residential care settings.
Measures to increase COVID-19 vaccination uptake among people using and providing Long-Term Care
Providing at home vaccination for people who are house-bound
Since the 31st March 2022, the Hong Kong Government have started home vaccination trial to provide a door-to-door COVID-19 vaccination service for citizens aged 70 or above who have not yet been vaccinated and people who are unable to leave home for vaccination due to illness or physical disability.
Considerations of making COVID-19 vaccinations mandatory among LTC staff and residents
On the 1st May 2021, following discussions with the governments of Philippines and Indonesia, and in light of concerns raised by labour groups, the government abandoned their proposal to make Covid-19 vaccination mandatory for foreign-born domestic care workers (many of whom provide domestic services to older people in their own homes). The proposal required foreign-born domestic workers to demonstrate they had received two doses as condition of approval or renewal of work visas. Covid-19 vaccination therefore remains voluntary in Hong Kong.
The Hospital Authority usually check all their new nurses for vaccination records and will “highly recommend” them to get vaccinated before starting employment. We are unsure about the current practice in Nursing Homes. The Hong Kong government has not published any data about the adoption of vaccination among healthcare workers.
Under the Residential Care Home Vaccination Programme administered by the Department of Health, it provides free Seasonal Influenza Vaccination and Covid-19 Vaccination for all residents and staff at residential care homes. Residents and staff who wish to receive vaccination would need to provide consent. Enrolled doctors, i.e. Visiting Medical Officers (VMOs), would administer vaccinations at residential care homes https://www.chp.gov.hk/en/features/21702.html. Besides, residents and staff can also arrange their own appointments to receive Covid-19 Vaccination in Community Vaccination Centres, private hospitals or clinics. Staff who have completed two doses of vaccination are exempted from the regular compulsory testing of Covid-19 https://www.covidvaccine.gov.hk/pdf/RVP_DoctorsGuide.pdf.
Mandatory vaccination for people moving into care homes
The Hong Kong Government announced on the 4th February 2022, that from the 14th March onwards, all persons newly admitted to the care homes must have received at least the first dose of a COVID-19 vaccine, unless COVID-19 Vaccination Medical Exemption Certificates is issued by doctors.
Update for: Hong Kong (China) Last updated: April 11th, 2022 Contributors: Cheng Shi |