HKJOT 2009;19(1):27–30

POSITION PAPER

OCCUPATIONAL THERAPY IN THE INTEGRATED

ELDERLY AND COMMUNITY SUPPORT SERVICES
FOR THE ELDERLY IN HONG KONG
Winglam W.L. Lai, Jessica P.Y. Chan, Pluto K.K. Choi, Lilac C.T. Ngai, Connie S.F. Mar,
Echo Y.L. Chan, Pok Y.P. Lam and Flora N.Y. Lam

The Integrated Elderly and Community Support Service supported by the Social Welfare Department
in Hong Kong has been in operation since November 2000. This paper is a brief review on the provision
of community occupational therapy services for the elderly in Hong Kong and sheds light on their
development in future.

KEY WORDS: Community • Elderly • Occupational therapy • Rehabilitation

Background to promote well-being of the elderly and to enable them to live

According to Population By-census conducted in 2006, there
are over 800,000 elderly people aged 65 or above, which
accounts for 12.4% of the total population in Hong Kong. Two
hundred thousand elderly people suffer from cognitive impair-
ment and 580,000 suffer from chronic illness in the community
(Census and Statistics Department, 2006). Elderly people re-
quire a lot of assistance from others. The care that they require
is not just simply home help services, which becomes more
complicated as their physical and mental conditions deterio-
rate owing to ageing. Therefore, we need to provide integrated
community-based rehabilitative service for service enhancement.
Current Community Services for the Elderly
With the concept of “ageing in place” and “continuum of care”,
a wide spectrum of community support services, including el-
derly centre services and community care services, are available
in the community as long as possible (Social Welfare
Department, 2008).
Among various elderly services, the Integrated Elderly and
Community Support Service, originally known as the Home
Help Service, was only responsible for providing simple per-
sonal care, meals-on-wheels, and household cleansing services.
This service was set up in recent decades to meet the increasing
needs of elderly services in the community. Since November
2000, the service has been, in general, divided into two services:
the Enhanced Home and Community Care Service (EHCCS)
and the Integrated Home Care Service (IHCS), and both types
of services have adopted a multi-disciplinary approach. Accor-
ding to the 2005–2006 and 2006–2007 reports by the Social
Welfare Department (2008), the main target group of the
EHCCS is older people aged 65 or above, who are in genuine
need of a well-coordinated home care and community support
service, and are assessed to be of moderate or severe impair-
ment in the Minimum Data Set for Home Care (MDS-HC)

Hong Kong Family Welfare Society, Hong Kong SAR, China.

Reprint requests and correspondence to: Pluto Choi, Hong Kong Family Welfare Society, 27–30, G/F, Sau Shan House, Cheung Shan
Estate, Tsuen Wan, New Territories, Hong Kong SAR, China.
E-mail: plutochoi818@gmail.com

Hong Kong Journal of Occupational Therapy 27

©2009 Elsevier. All rights reserved.
Winglam W.L. Lai, et al
assessment. For the IHCS, the main target group is older peo-
ple aged 60 or above, with moderate or severe impairment in
the MDS-HC, and they must be people with disabilities or indi-
viduals and families with social needs.
Occupational Therapy Services in the
Community
With the primary goal of enabling people to participate in
activities of daily living (ADL) and the holistic belief that the
level of participation can be supported or restricted by physical,
social, attitudinal and legislative environments, occupational
therapy practice is directed to different aspects to better support
participation, which includes sensory, motor, cognitive, psy-
chosocial and environmental aspects (World Federation of
Occupational Therapist, n.d.).
After thorough assessment, an individualised care plan
will be established for every elderly person. Treatment will be
provided for an in-home or centre basis. Occupational thera-
pists prescribe remedial activities for enhancing functional
performance level in ADL and instrumental ADL, as well as
simulated or on-site training for daily living skills. Apart from
individual training, therapeutic groups are also implemented
in the treatment.
For a compensatory approach, rehabilitation aids will be pre-
scribed and adaptive techniques will be educated to the elderly
according to their needs. The home environment will be in-
spected and ways of modification will be suggested if indicated.
The three aspects of occupational performance (self-care,
work and leisure, and self-care and leisure) will be more focussed
in the treatment plan for older clients living in the community, as
most of them have already adopted the retired role or the occupa-
tion of household work in the family. Moreover, a large group of
older clients are home-bound because of environmental barriers,
different body impairments (no matter physical or mental), or
lack of social network in leisure or social activities. Increasing
evidence shows that leisure or social activities are important in
enhancing positive identities and self-esteem of the elderly.
Leisure acts as a context for realising and utilising human
strengths and resilience, and increasing sense of independence
(Iwasaki, 2007; Searle, Mahon, Iso-Ahola, Sdrolias, & Dyck,
1998). Therefore, purposeful activities are very significant in
improving psychological well-being among the elderly, and
maintaining their proper level of responses to external stimuli
and participation in daily tasks, thus improving quality of life.
In view of this, occupational therapists in the community
often need to explore the social background and interest of the
clients, to design specific therapeutic cognitive or psycho-
social activities.
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HKJOT 2009;19(1)
Effectiveness of Community Rehabilitation
Services
Currently, the elderly in Hong Kong need to wait for 40.5 months
on average for vacancy of living institutions (“Thousands of
elderly die every year”, 2009). There is a service gap after the
elderly are discharged from the hospital and before they are
admitted to institutions. Active rehabilitation for those elderly
people during this period is essential for them to continue to
function and to delay deterioration. It is also important to facil-
itate their adaptations to community living, reduce the stress
of caregivers, and maintain quality of life of the elderly, with
the use of occupational therapists who contribute to functional
training, modifying the environment, advice in the use of
assistive devices and providing caregiver education.
Local community-based rehabilitation programmes such
as the EHCCS or the IHCS are designed to actualise the con-
cepts of “ageing in place” and “continuum of care”, to enable
the elderly to continue living in the community (Social Welfare
Department, 2008). They allow elderly ageing at home, a famil-
iar environment, and provides caregiver support to promote
their quality of life. The majority of both EHCCS services
users and their caregivers agree that the services can enhance
home safety, reduce frequency of hospitalisation, enable the
elderly to stay in a familiar environment continuously, and
lower the demand for residential care homes for the elderly
(Social Welfare Department, 2008).
Community occupational therapy was found to significantly
improve ADL and quality of life in various types of elderly
people, such as elderly people suffering from stroke, dementia
or rheumatoid arthritis, or elderly people with a risk of falling,
and it also reduces caregiver burden (Graff et al., 2006; Walker
et al., 2004; Wilkins, Jung, Wishart, Edwards, & Norton, 2003).
There is evidence that community rehabilitation is more effec-
tive when provided in the elderly’s own living environment,
and it would be easier to generalise what they learned to real-
life environment (Wade, 2003). It also helps retain elderly
people in the community as long as possible and reduce the
pressure of high demand from institutions.
Home visits from occupational therapists are believed to be
effective to reduce the risk of falls in the elderly, which is not
only because of home modification but also for easier moni-
toring and education in behavioural safety (Cumming et al.,
1999). Through regular home visits, community occupational
therapists can understand more about the common behaviour
and daily habit of the elderly, such as the inappropriate use of
adaptive aids, which will induce domestic accidents. Therapists
can easily identify and work with those risk factors. Effective-
ness of falls prevention programmes shows that there are less
Hong Kong Journal of Occupational Therapy

hospital admissions caused by falls, and that there is more cost
effectiveness in services provision if falls can be prevented
(Cumming et al., 1999).
Obstacles in Community-based
Rehabilitation
Researchers have identified the common obstacles for
community-based rehabilitation. First, it was identified that
the home environment with a small space and scarce equipment
could sometimes pose a limitation to rehabilitation (Enderby &
Wade, 2001). In Hong Kong, the home environment is much
smaller than that of other countries because of high population
density. As a result, there is limited space to carry out rehabil-
itation in the home environment. For example, it is very diffi-
cult to find a suitable table to carry out some cognitive
activities such as card games in the elderly home, as the table
is too small or full of possessions. In addition to limited space,
lack of equipment in the home environment also hinders reha-
bilitation. Some complicated treatments cannot be carried out
because of a lack of equipment. For instance, the rehabilitation
for people with cognitive problems or hand function training
is limited, as it is difficult to bring a cognitive training kit or
hand function training equipment for rehabilitation at home.
Second, the effectiveness of community-based rehabilitation
is highly affected by the external environment and the attitude
of caregivers (Enderby & Wade, 2001). The home environment
is full of distractions such as TV, telephone, noise from neigh-
bours, and conversation from family members or visitors. As a
result, elders cannot concentrate on carrying out rehabilitation.
In addition, the attitude of caregivers affects the compliance
of treatment. In community-based rehabilitation, family mem-
bers of the elderly have the important role of decision making
(Mishra, 2003). They may make decisions, which are not the
best choice from their point of view. They may refuse training
when elderly people show low motivation.
Future Development
In view of the increasing number of elderly people with
Alzheimer disease and mild cognitive impairment among the
ageing population and the limited equipment that is available
in the home environment, community occupational therapists
should develop a portable cognitive training kit, which consists
of a set of comprehensive therapeutic games to facilitate cogni-
tive training to be conducted in the home environment (Ng
et al., 2006). Since elderly people are living in the community,
the design of the materials in the kit should be made comparable
to the real-life situation so that they can better generalise the
Hong Kong Journal of Occupational Therapy
TREATMENT OF SPASTIC PRONATORS IN CHILDREN
cognitive skills to their daily life. Besides individual treatment,
the cognitive training kit can also be designed for group use by
which home programmes could be carried out by family
members of the elderly.
Reminiscence has been shown to increase self-esteem
(Lappe, 1987), life satisfaction (Merriam & Cross, 1982), and
participation levels (Haight, 1988). In order to resolve a life
crisis, that is integrity versus despair at old age (Erikson,
1982), community occupational therapists should carry out
reminiscence activities with elderly people to encourage them
to look back at their entire lifetime, try to resolve unresolved
past conflicts, accept negative experiences, celebrate accom-
plishments and good experiences, and overall, feel a sense of
accomplishment and closure with their lives (Butler, 1963).
Meanwhile, a life story book can be made to record one’s life
events and feelings. In order for more elderly people to benefit
from reminiscence, occupational therapists can design a tem-
plate of a DIY life story book to encourage the younger gen-
eration to conduct reminiscence for their grandparents (Lai &
Mok, 2002). Community occupational therapists can make
use of reminiscence as a means to promote communication
and social interaction among elderly people to prevent social
withdrawal, which is commonly seen in the elderly population
who live alone or with chronic illnesses.
Community visits provide an opportunity for occupational
therapists to become acquainted with and understand the daily
habit and routine of the clients in their daily life. Risky and
undesired behaviour can be identified during home visits.
Using lifestyle redesign, the quality of life of clients can be
increased. It can promote a safe environment for clients, and
occupational therapists can explore the interests of clients,
which can maximise their functional abilities and promote a
meaningful life for the clients.
“Train-the-trainer” approach for caregiver training at home
would be effective to facilitate the caregivers to learn and
incorporate their skills in daily living tasks for the elderly
with dementia, stroke, diabetes mellitus or chronic obstructive
pulmonary disease, or those who have had falls. It is possible
to further develop different training packages to serve care-
givers of clients with different needs, for example, depression,
orthopaedic problems and Parkinson disease.
Each organisation has its own expertise, and therefore,
collaborating with different non-government organisations to
form an elderly backup network would be an effective means
to utilise the community resources effectively. For example,
the Elderly Resource Centre of the Hong Kong Housing
Society provides a series of screening tests for falls prevention
to enhance the safety of elderly in the community. With better
use of resources, provision of community services can be
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Winglam W.L. Lai, et al
integrated in a more holistic approach for better treatment
implementation.
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