LCQ17: Support for persons with severe intellectual disabilities
19.4.2023

Following is a question by the Hon Tang Ka-piu and a written reply by the Secretary for Labour and Welfare, Mr Chris Sun, in the Legislative Council today (April 19): Question: It is learnt that persons with severe intellectual disabilities (ID) graduating from special schools and requiring tube feeding will be assessed by the Social Welfare Department (SWD) as having a "very high nursing care need" and "falling outside the scope of Care and Attention Homes for Severely Disabled Persons (C&A/SDs)" when they apply for residential services provided by the Government and, as a result, they can only wait for admission to the Siu Lam Hospital. Some carers of persons with severe ID consider that hospitalisation care renders those persons lacking in the opportunities to interact with the outside world, and it not only neglects their right to fair development, but may also cause their living skills to deteriorate rather than improve. Moreover, with the popularisation of minimally invasive gastrostomies at present, feeding and providing nursing care to relevant patients are simpler as compared with the past. Some persons with severe ID residing in C&A/SDs can continue to reside in their original residential care homes (RCH) after undergoing gastrostomies, reflecting that C&A/SDs should be capable of providing nursing care to those persons. In this connection, will the Government inform this Council: (1) whether the SWD has any plans to examine, review and adjust the Standardised Assessment Mechanism for Residential Services for People with Disabilities (including the Standardised Assessment Tool for Residential Services for People with Disabilities) and the residential service allocation mechanism under the Central Referral System for Rehabilitation Services, such as adjusting the levels of nursing care needs of different service targets in light of the development in nursing care technologies as well as opening up accordingly suitable RCH waiting places for persons with severe ID; if so, of the details; if not, the reasons for that; (2) of the current number of persons waiting for the Mental Handicap Infirmary and Rehabilitation Services of the Siu Lam Hospital and the average waiting time; whether it knows the number of additional beds for Mental Handicap Infirmary and Rehabilitation Services to be provided by the Hospital Authority (HA) in the coming five years, and whether the HA has considered introducing the relevant services in other hospitals (in particular hospitals located in urban areas), so as to make it more convenient for carers to visit persons receiving the relevant services; (3) as it is learnt that some carers need to frequently accompany persons with severe ID living at home to travel to and from hospitals, RCHs and/or day care centres and need to purchase rehabilitation products at their own expense, resulting in heavy financial and mental burdens on them, whether the Government will consider (i) increasing the number of places of day and residential respite services suitable for persons with severe ID, and (ii) relaxing the eligibility criteria for the Pilot Scheme on Living Allowance for Low-income Carers of Persons with Disabilities; if so, of the details; if not, the reasons for that; and (4) as some carers of persons with severe ID have relayed that persons with ID who need to use invasive mechanical ventilators or receive haemodialysis are not eligible for the Mental Handicap Infirmary and Rehabilitation Services of the HA, while other subsidised and private RCHs may refuse to admit such persons on various grounds, how the authorities resolve the problems concerned? Reply: President, In consultation with the Health Bureau, on behalf of the Government, I provide the following consolidated reply to the question raised by the Member as follows: (1) The Social Welfare Department (SWD) has adopted the Standardised Assessment Tool for Residential Services for People with Disabilities to identify the service needs of persons with intellectual/physical disabilities applying for residential services, and match their needs with appropriate levels and categories of services. The Assessment Tool was devised upon discussion by a working group, comprising different professionals including physicians, physiotherapists, occupational therapists, nurses and parent representatives, repeatedly tested and evaluated to establish its reliability and validity, and is generally supported by the sector and stakeholders. The SWD will review the Assessment Tool as and when necessary. (2) At present, Siu Lam Hospital (SLH) of the Hospital Authority (HA), with a total of 520 beds, provides territory-wide infirmary and rehabilitation inpatient services for adults with severe or profound intellectual disability. As of December 31, 2022, the number of persons on the central waiting list (active cases) was 19 and the median waiting time was 1.3 months. The HA will regularly review the demand for various medical services. In respect of adults with severe and profound intellectual disability, the HA will continue to closely monitor the operation and utilisation of the infirmary services in SLH and plan for the development of its services having regard to factors such as overall patients' needs, related resources and support, and healthcare manpower supply, and adopt measures to strengthen support for these patients. (3) As at end-March 2023, the SWD provides 172 day respite service places and 403 residential respite places for persons with disabilities. All day respite service places and 217 residential respite places are suitable for persons with severe intellectual disabilities. In 2023-24, the SWD will provide 36 additional residential respite service places for persons with disabilities and will continue to provide additional respite service places in the newly set up District Support Centres for Persons with Disabilities, subvented residential care homes for persons with disabilities (RCHDs) and RCHDs participating in the Bought Place Scheme for Private Residential Care Homes for Persons with Disabilities with a view to strengthening the support for carers. Moreover, home-based support services (including home respite service) for persons with severe disabilities are provided through the Home Care Service for Persons with Severe Disabilities and the Integrated Support Service for Persons with Severe Physical Disabilities. The Government will regularise the Pilot Scheme on Living Allowance for Low-income Carers of Persons with Disabilities (carer allowance) currently under the Community Care Fund (CCF) in October 2023 and increase the monthly allowance from $2,400 to $3,000 to help supplement the living expenses of the carers. The carer allowance mainly aims to subsidise low-income carers and the eligibility criteria for the carer allowance are already more lenient than those for the Comprehensive Social Security Assistance (CSSA) Scheme which provides assistance to persons in financial need. To ensure the proper use of public money, the Government has no plan to relax the eligibility criteria of the carer allowance at this moment. Moreover, the Government will also regularise the Special Care Subsidy for the Severely Disabled currently under the CCF in October 2023 and increase the monthly full grant from $2,000 to $2,500 to provide persons with severe disabilities who are living in the community and not receiving the CSSA with a subsidy for purchasing care goods and services, or for other purposes related to nursing care, in order to strengthen support to persons with severe disabilities in need. (4) At present, SLH is a hospital providing comprehensive rehabilitation and infirmary services exclusively for patients with severe intellectual disability aged 16 or above. Its environment, facilities and staffing are designed to cater for the needs of persons with severe intellectual disability who are generally in stable condition and require long-term nursing care. According to section 3(a) of the Residential Care Homes (Persons with Disabilities) Regulation (Cap. 613A), a "high care level home" (whether subvented or private) is an establishment providing residential care for persons with disabilities who are generally weak in health and lack basic self-care skill to the extent that they require personal care, attention and assistance in the course of daily living activities but do not require a high degree of professional medical or nursing care. In general, patients on invasive mechanical ventilation or haemodialysis must be taken care of by healthcare workers who have received relevant specialist training and there are specific requirements on the environment and facilities. As the above treatments require suitable environment, facilities and professional staff, RCHDs and public hospitals generally providing infirmary services (including SLH) are unable to cater for the special treatment needs of these two types of patients. The Government will continue to discuss how to meet the relevant demand.