Presented at the 2007 AARP Conference on Presented at the 2007 AARP Conference on ““Reinventing Retirement Asia: Enhancing the Opportunities of Reinventing Retirement Asia: Enhancing the Opportunities of

AgingAging””March 14March 14--16, 200716, 2007

JapanJapan

Prof. Alfred C M Chan PhD BBS JPProf. Alfred C M Chan PhD BBS JPViceVice--chair, Elderly Commission, HKSARchair, Elderly Commission, HKSAR

AsiaAsia--Pacific Institute of Ageing Studies (APIAS)Pacific Institute of Ageing Studies (APIAS)Department of Sociology and Social Policy Department of Sociology and Social Policy

Lingnan University, Hong KongLingnan University, Hong KongEE--mail: mail: sscmchan@LN.edu.hksscmchan@LN.edu.hk

Innovative Approaches -From family to community care: Training and recognition of care givers in Asia-Pacific countries

OutlineOutline

• Changing population structure- creating demand for trained caregivers

• Increasing credentials & professionalism- Less supply of skilled caregiversDemand for more, and better skilled caregivers

• A new mindset, a new model for care givers training and recognition- matched needs with skills- bridging voluntary & professional care

the qualification framework

Percentage of Elderly Population 65+Percentage of Elderly Population 65+1990, 2010, 20251990, 2010, 2025

Percentage of Aged 60+ in Percentage of Aged 60+ in the Asiathe Asia--Pacific regionPacific region

1011 11

16

26

13 1311

8

18

0

5

10

15

20

25

30

The ESCAPregion

China DemocraticPeople's

Republic ofKorea

Hong Kong,China

Japan Republic ofKorea

Singapore Thailand India Australia

AsiaAsia--Pacific: Total Fertility Pacific: Total Fertility rates (1970rates (1970--2000)2000)

0 1 2 3 4 5 6 7

Philippines

Malaysia

Indonesia

Thailand

China

Singapore

Taiwan

South Korea

Japan

Hong Kong

1970

1980

2000

Thailand

2006 Ageing Index2006 Ageing IndexThe potential support ratio is the numbers of aged 15 to The potential support ratio is the numbers of aged 15 to

64 per person aged 65 or older 64 per person aged 65 or older

37 .453 .5 46 .8

108 .8

189 .1

69 .3 68 .146 .9

25 .4

91 .6

0

20

40

60

80

100

120

140

160

180

200

The

ESC

AP

regi

on Chi

na

Dem

ocra

ticPe

ople

'sR

epub

licof

Kor

ea

Hon

gK

ong,

Chi

na

Japa

n

Rep

ublic

of K

orea

Sing

apor

e

Thai

land

Indi

a

Aus

tral

ia

Sex Ratio of Population Aged 65+ in Sex Ratio of Population Aged 65+ in the Asiathe Asia--Pacific region (M per 100F)Pacific region (M per 100F)

8286

72

87

7370

8479

88

80

0

10

20

30

40

50

60

70

80

90

100

The ESCAPregion

China DemocraticPeople's

Republic ofKorea

Hong Kong,China

Japan Republic ofKorea

Singapore Thailand India Australia

An overall push for trained care giversAn overall push for trained care givers……

Population ageing: rising demands for careSheer rise in numbers & longevity, decline in fertilityDeclining family support:

- nuclear families now dominant, with rising single parenthood- rising divorce rates, declining family support

Growing demands for high quality care demands for formal, trainedDemand for credentials & professionalism care givers

Types of care needed:From acute to chronic illnesses short care to long term careFrom health to social care less technical, more broad psectrum

Resulting high cost formal care

Similar Trends in Asian countries: e.g.Hong Kong, Singapore & Australia

Situations in Hong KongSituations in Hong KongYear 2001

Age above 60:1 million (14.9%)

Life expectancy:Male 81.4 years oldFemale 86 years old

Sex Ratio:Male 48%

Female: 52%

Year 2031

Age above 60:2.7 million (31.3%)

Life expectancy:Male 84.6years old

Female 89.1 years old

Sex Ratio:Male 42.7%

Female: 57.3%

Situation in SingaporeSituation in Singapore

Singapore (National survey of 2005)• 85.5% seniors live with families;

29% depend on a main caregiver to care for their daily personal needs

• 85.5 % seniors (aged 65-74) with one or more chronic illnesses

Increased credentials requirements: Increased credentials requirements: Supply ratio of professionals in HKSupply ratio of professionals in HK

O.T. P.T. Nurse S.Wkers

All on register

1120(31/3/2005)

1835(31/3/2005)

24965(31/8/2004)

12354(1/1/2006)

ratio 1:747 1:456 1:34 1:68

Take total aged 65+ = 836400 in mid 2005

•Professionals: degrees, specialist, boundaries

•Care givers:over-reliance, role-exclusion, powerless

•Older person: totally helpless, no choice

Demands for professionals supply costs

Setting a new mind set: Setting a new mind set: a needsa needs--based modelbased model

• Ideal for an older person to be cared at home: - medically stable, regular, lower level care- family for personal care (spouse or same sex)- 24hr availability, incl. support for care givers

• Resuming the multi-skilled persons model– informal-voluntary: the central role of family

members, & neighbours– ‘qualified’ technicians meeting intermediate

care needs– Engage professionals only for high level needs

24-hrsMedical

attention

Bed bound But stable

Basic careSelf+others

Ass. living

Needs-skills well matched

Tasks performed by ordinary persons with common senses& self care skills

Personal care tasks with some trainings to care frail persons: diabetes injection, wound cleansing, tube feeding etc.

Skilled & highly skilled tasks requiring accreditations: doctors, nurses, social workers, etc.

What can be done to increase the What can be done to increase the numbers of skilled caregivers?numbers of skilled caregivers?

• Strengthen & recognize less-formal training (next generation more able) – Enhance the abilities of family members, the

community, and society– Recognition of skills Vs book knowledgeobserved assessments Vs Exams.

• Multi-skills at basic level for caregivers– Nursing & para-medical care, psychological

care and social care– Personal care, home safety, health promotion,

dementia management & caregiver support

Qualification Framework: Qualification Framework:

the City & the City & GuildesGuildes (UK) model(UK) model

• QF equivalent: National Vocational Qualification

– natural progression from basic to advanced levels (1-7)

–allows younger generation with all abilities to engage at appropriate levels

– Location based assessments, accredited training, examination and accreditation centres; continuous assessment

• No age, education barriers

Level Qualifications Definitions7 Fellowship (FCGI) The highest level of technological and

managerial experience6 Membership (MCGI) At the level of Master’s degree5 Graduateship (GCGI)

Associateship (ACGI), NVQ5At the level of first degree

4 Licentiateship (LCGI) / NVQ 4Full Technological DiplomaFull Technological CertAdvanced Technician Diploma

Demands specialist or technical expertise and the ability to undertake professional work, at

the level of Master Craftsman in Europe

3 Technician Diploma,(IVQ)NVQ 3

Denotes skilled work of a complex nature and the ability to undertake a supervisory

role2 Technician Certificate (IVQ)

NVQ 2Recognises competence in a more

demanding range of activities which require a degree of individual

responsibility1 Vocational Certificate (IVQ)

NVQ 1Indicates the ability to perform basic or

routine activities, provide the broad foundation for progression

Progressive Structure 1-7

New teaching and learning perspective: New teaching and learning perspective: Proposed Qualification Framework in health careProposed Qualification Framework in health care

• Qualification framework can be classified into 3 levels (sub degrees)– Level 1: basic care skills for seniors (all skills-

based, e.g.self care, health knowledge)– Level 2: Clinical practice in health care setting,

report writing skills and able to apply general care principles to practice (i.e. skills+languagetraining for reporting e.g. non-invasive supportive skills like lifting, hygiene)

– Level 3: Good knowledge of medical terminology, and proficiency in language which able to meet the admission requirements of vocational training institutions, articulation to professional/degree training (i.e. care skills+ subject knowledge +language)

An example of levelAn example of level--2 training2 training

• Full award = 6 units + 1 optional unit•• Core•• 1. Communication

2. Health promotion and Safetyin environment 3. Developing Knowledge and practice (this will include aspects of care planning, protection and well-being, support daily living)4. Support domestic care (this will include eating & drinking, continence, personal care)5. Physical comfort (this will include emotional support)6. Rights and Responsibilities in Health and Social Care

•• Optional units•• 1. Therapeutic Activities (esp. for mildly demented)

2. Maintaining mobilities3. Collaboration with informal carers

•

A new training and recognition modelA new training and recognition model

• Government accreditations: authority for registration

• Assessments and examinations: Academic or professional institutes; on location, evidence-based assessments with/without exams. (i.e. defined syllabus & standards)

• Training bodies: NGOs, schools, self-taught (for levels 1,2)

• Assessors and training of assessors: operate independently, year-round

From unskilled to skilled, informal(unpaid) to formal (paid)

Building a neighborhood caregivers network: Building a neighborhood caregivers network: Possible Roles of Schools Possible Roles of Schools

as happening in other Asian cities as happening in other Asian cities e.g.Taiwane.g.Taiwan, Singapore, Singapore

• Encourage intergeneration ideasresponsibilities amongst students

• Empower students for basic health skills competence (level one e.g. first aids, coping with demented grannies)

• Providers of level 1, 2 QF training, targeting at community health technician jobs

Thank You!!!Thank You!!!Asia Pacific Institute of Asia Pacific Institute of

Ageing Studies, Ageing Studies, Lingnan UniversityLingnan University