CADENZA Symposium 2007:Preparing for an

Elder Friendly Hong Kong

8 – 10 January 2007 (Monday – Wednesday)Rayson Huang Theatre, The University of Hong Kong

CADENZA:A Jockey Club Initiativefor Seniors

The Hong Kong Jockey Club Charities Trust launched the five-year, HK$380 million CADENZA project in 2006, designed tofoster positive community attitudes toward older people and improvethe quality of care and quality of life for Hong Kong elderly.

The Project name is an acronym for "Celebrate their Accomplishments;Discover their Effervescence and Never-ending Zest as they Age."Cadenza is a musical term for a virtuoso solo passage near the end of aconcerto movement. The word is used figuratively to refer to the apexof one's life and one's cumulative accomplishments.

According to Hong Kong census population projections, up to 27%of the city's populace will be 65 or over by 2033. This is an increasefrom about 796,000 in 2003 to more than 2.26 million in 2033. Inpreparation for the ageing of its citizens, Hong Kong, like manyother ageing communities world-wide, must become increasinglyelder-friendly.

CADENZA has five complementary components: 1) public educationfor the mainstream population; 2) infusion of gerontological curriculaand practica in social work and other disciplines and in-depth trainingin gerontology for social workers and other helping professions;3) development of innovative models for integrating elderly care intothe community; 4) leadership development in gerontology amongacademia and senior practitioners; and 5) research and evaluation toadvance evidence-based practice in elderly care.

CADENZA Symposium 2007: Preparing for an Elder Friendly Hong Kong

0915 Welcoming RemarksProfessor Lap-Chee TsuiVice-ChancellorThe University of Hong Kong

0920 Opening AddressMr William Y YiuExecutive Director, CharitiesThe Hong Kong Jockey Club

0925 Officiating AddressDr the Hon York Chow SBS JPSecretary for Health, Welfare and FoodHealth, Welfare and Food Bureau

0935 Souvenirs PresentationMr William Y Yiu

Professor Ian HollidayDean, Faculty of Social SciencesThe University of Hong Kong

0945 Keynote AddressDr the Hon Leong Che-hung GBS JPChairmanElderly Commission

1010 Tea Break

1040 Presentation 1:Understanding Ageing Experience:A Life Story Perspective

Professors Denise Burnette & Ada MuiColumbia University School of Social Work

1210 Open ForumPanelistsProfessor Denise Burnette

Professor Cecilia Chan JP (Discussant)Department of Social Work andSocial AdministrationFaculty of Social SciencesThe University of Hong Kong

Dr Kong Tak Kwan (Discussant)Consultant GeriatricianDepartment of GeriatricsPrincess Margaret Hospital

Professor Ada Mui (Moderator)

1300 Lunch

1430 Presentation 2:Creative Ageing: Meaningful SocialEngagement

Professor Nancy Morrow-HowellGeorge Warren Brown School of Social WorkWashington University in St. Louis

Professor Ada Mui

1600 Tea Break

1630 Open ForumPanelistsProfessor Nancy Morrow-Howell

Professor Alfred Chan BBS JP(Discussant)Director, Asia Pacific Institute of Ageing StudiesLingnan University

Professor Nelson Chow MBE SBS JP(Discussant)Department of Social Work andSocial AdministrationFaculty of Social SciencesThe University of Hong Kong

Miss Tung Kwai Yung (Discussant)Vice President (Education)Mandarin Toastmasters Club of Hong Kong

Professor Ada Mui (Moderator)

1730 End of the Programme

8 January 2007 (Monday)

1000 Round-table Discussion (Session 1):Re-thinking Long-term CareVenue: Conference Room, CADENZA Office

Room 104, Meng Wah Complex, HKU

Round-table Discussion (Session 2):Creative Ageing IdeasVenue: Conference Room

Faculty of Social Sciences OfficeRoom 401, Meng Wah Complex, HKU

1200 Lunch

1430 Round-table Discussion (Session 3):Senior and Youth Vision IVenue: Conference Room, CADENZA Office

Room 104, Meng Wah Complex, HKU

Round-table Discussion (Session 4):Senior and Youth Vision IIVenue: Conference Room

Faculty of Social Sciences OfficeRoom 401, Meng Wah Complex, HKU

1630 End of the Programme

0900 Presentation 3:New Ways of Thinking about Long-term Care

Professor Rosalie A KaneSchool of Public Health, University of Minnesota

Professor Kevin J MahoneyBoston College Graduate School of Social Work

1030 Tea Break

1045 Presentation 4:Consumer-directed Care and Quality ofLife of Older People in the Community:The Cash and Counselling Experience

Professor Kevin J Mahoney

1120 Presentation 5:Examples of How to Enhance Qualityof Life of Older People in ResidentialFacilities

Professor Rosalie A Kane

1200 Open ForumPanelistsProfessor Rosalie A Kane

Professor Kevin J Mahoney

Dr Lam Ching-choi JP (Discussant)Chairman, Working Group on Long Term CareModel Elderly Commission

Ms Anita Wong (Discussant)Convenor, Resource Group on Long Term Care SystemThe Hong Kong Council of Social Services

Professor Terry Lum (Moderator)School of Social Work, University of Minnesota

1300 Lunch

1430 Presentation 6:Rebalancing Residential Care andCommunity-based Care: Possibilitiesand Challenges

Professor Robert L KaneSchool of Public Health, University of Minnesota

1600 Tea Break

1630 Open ForumPanelistsProfessor Robert L Kane

Mr Kwok Lit Tung (Discussant)Director, Christian Family Service Centre

Professor Jean Woo (Discussant)Head, Division of GeriatricsDepartment of Medicine & TherapeuticsThe Chinese University of Hong Kong

Dr Lam Ching-choi JP (Discussant)

Ms Anita Wong (Discussant)

Professor Terry Lum (Moderator)

1730 End of the Programme

9 January 2007 (Tuesday) 10 January 2007 (Wednesday)

* Participation in the Round-table DiscussionSessions will be by invitation only.

Denise Burnette, Ph.D.

Dr Denise Burnette is a professor at theColumbia University School of Social Work.She has many years of clinical practiceexperience with elderly populations as well asresearch experience on ageing issues. Herresearch focuses on three main areas of healthand social care for the elderly: formal care,informal care, and self-care. Her work onformal services examines service needs andservice utilization among older adults. Herresearch on family caregiving focuses ongrandparents who are raising grandchildren infamilies that have been disrupted by social andhealth problems. And her work on self-careexplores how the elderly manage chronic healthconditions in their daily lives. She is also anexpert in developing media programmes toimprove the teaching and learning of geriatricsocial work practice. Dr Burnette is currentlyvisiting India as a Fulbright Scholar.

Speakers’ Biographies

Rosalie A Kane, Ph.D.

Dr Rosalie A Kane is a professor at the Schoolof Public Health at University of Minnesota,where she is also a graduate faculty member ofthe School of Social Work, the Centre forBioethics, and the Centre on Ageing. She hasan extensive record of leadership in research,policy analysis, and technical assistance onageing, disability, long-term care, and socialwork and psychosocial well-being in healthsettings. She is the author or a co-author ofmore than a dozen books and hundreds ofjournal articles and chapters, and is past editor-in-chief of both Health and Social Work, and ofThe Gerontologist. Dr Kane served on threeInstitute of Medicine Committees, includingthe Committee on Regulation of NursingHomes, which was the precursor to the 1987Nursing Home Reform Act. She is presentlyconducting an 8-state study of State practicesto rebalance long-term care services for allage groups and populations from institutionsto home and community-based servicesusing relative utilization and expenditures inboth sectors as the markers of rebalancingeffectiveness. She was the principal investigatorfor the evaluation of the first Green Housenursing home in Tupelo, Mississippi. Dr Kaneis the recipient of the Gerontological Societyof America’s Kent Award.

Robert L Kane, M.D.

Dr Robert L Kane is an endowed chair professorin long-term care and ageing at the Universityof Minnesota. He directs the University ofMinnesota’s Centre on Ageing, the MinnesotaArea Geriatric Education Centre, the ClinicalOutcomes Research Centre, and the Evidence-based Practice Centre. His current researchaddresses both acute and long-term care forolder persons, with special attention to the roleof managed care, chronic disease, and disability.Dr Kane consults to a number of national andinternational agencies, including the WorldHealth Organization’s Expert Committee onAgeing. He has received the President’s Awardfrom the American Society on Ageing and thePolisher Award from the Gerontological Societyof America.

Ada Mui, Ph.D.

Dr Ada Mui is a professor at the ColumbiaUniversity School of Social Work. Since joiningthe Columbia faculty in 1990, Dr Mui hastaught gerontology, research methods, andstatistics courses in the School’s M.S. andPh.D. programmes. Dr Mui has extensive socialwork practice experience in Hong Kong and inthe United States. Her research is primarily basedon her clinical work with the elderly in a widerange of settings, including community,hospital, home care, continuum of care system,nursing home, and hospice. In the last decade,Dr Mui has been recognised as one of the leadingsocial gerontologists in cross-cultural researchin the United States. She has been a recipientof many research awards and FulbrightScholarships. Currently, she is a fellow of theGerontological Society of America.

Nancy Morrow-Howell, Ph.D.

Dr Nancy Morrow-Howell is the Ralph andMuriel Pumphrey Professor of Social Work atWashington University. Her research interestsinclude community and mental health servicesto frail elders and the development ofproductivity and civic engagement in later life.She is the Principal Investigator for agovernment-funded research project thatfocuses on depression treatment in communitylong-term care; a MetLife funded project onolder adults in service to society; and anAtlantic Philanthropy funded project toevaluate the Experience Corps - a nationalelderly volunteer programme. She received boththe Washington University DistinguishedFaculty Award and the George Warren BrownSchool of Social Work Outstanding FacultyAward. Dr Morrow-Howell is currently theeditor of the Practice Concepts section of TheGerontologist.

Kevin J Mahoney, Ph.D.

Dr Kevin J Mahoney is a professor at theBoston College Graduate School of SocialWork and is the National Program Director forthe Cash and Counselling Demonstration andEvaluation, a policy-driven evaluation of oneof the most unfettered forms of consumer-directed personal assistance services. During his30-year career in gerontology and long-termcare, Dr Mahoney has served in a number ofhigh-level policy making and administrativeposit ions in the state governments ofConnecticut and California. An expert on stategovernment and long-term care innovation, hespeaks and writes extensively on consumerdirection, the roles of the public and privatesectors in financing long-term care, long-termcare insurance and care management.

Abstracts

Understanding Ageing Experience: ALife Story Perspective

Professors Denise Burnette & Ada Mui

Longer lives are both an individual privilegeand a significant societal achievement. Butolder adults and ageing populations alsopresent new challenges that will impactupon all facets of 21st century societies —challenges that are too wide-ranging andcomplex to be addressed by public orprivate sectors alone. Collaborativeapproaches and multiple strategies will beneeded to ensure that individuals maintaina high quality of life as they age and thatsocieties integrate and use the time andtalents of all their citizens. In this session,I will use a developmental life courseperspective to examine how individualdevelopment and ageing are intricately andinextricably linked with the broader socio-historical contexts in which they occur. Iwill begin with a brief overview of the mainideas of the life course perspective. I willthen introduce an illustrative life story.Drawing on elements of this particularlife story, I will show how individualbiographies can be used to illuminate andinform professional practice and publicpolicy in an ageing society.

Creative Ageing: Meaningful SocialEngagement

Professors Nancy Morrow-Howell & Ada Mui

With the increase in life expectancy, olderadults can expect to live 20-30 years after theyleave the workforce. This is a victory formodern medicine and public health but achallenge to how we think about the roles ofpeople in later life. It is time to rethink whatwe want and could do with those extra yearsof life. Duration of life by itself may not bethe goal, but the quality of life that can beachieved within those extended years. Formany people, quality of life requires that theybe meaningfully engaged in social and civiclife. Older adults express a desire to continueto work, to perform important volunteer rolesin their community, to undertake creativeendeavors, to care for the younger generation.These roles are important to the well-being ofthe older adult; but just as importantly, societybenefits from the vital involvement of its oldercitizens. Yet societies do not have thesemeaningful roles available to older adults.Model programmes and policies aredeveloping that seek to provide opportunitiesfor on-going engagement. In this presentation,we will review programmes and policiescurrently being implemented that expand theengagement of older adults in work, volunteer,and educational roles.

New Ways of Thinking about Long-term Care

Professor Rosalie A Kane

Based on current research and knowledge, this presentationwill identify principles that should be built into long-termcare systems. The presentation will particularly concentrateon principles related to residential long-term careprogrammes, where both quality of life and quality of careare at stake. Distinctions are made between therapeutic goals,which are measured by improvement or delay in deteriorationof functioning, on the one hand, and compensatory goals,which refer to enabling a person to live as meaningful a lifeas possible despite the person’s physical and/or cognitiveimpairments. The presentation emphasises three recent areasof emphasis: 1) the importance of physical environmentsthat enhance functioning; 2) issues in organising a caregivingstaff to optimally meet resident needs; and 3)individualisation of the care of residents according to theirneeds and preferences.

Professor Kevin J Mahoney

This presentation will identify principles that should bebuilt into community-based long-term care. Thepresentation will concentrate on principles related toconsumer choices, quality of care, and quality of life. Afterexamining some of the demographic and attitudinal factorsaffecting the delivery of community-based services, we willview a short film showing the differences betweentraditional agency-delivered services and consumer-directedoptions, and then discuss the principles or vision underlyingconsumer-directed care from person-centred planningthrough managing and improving quality.

Consumer-directed Care and Quality ofLife of Older People in the Community:The Cash and Counselling Experience

Professor Kevin J Mahoney

Today, throughout most of the United States,whether you are a senior or a younger personwith disabilities, if you need help with suchpersonal activities as bathing and dressing andyou need assistance from a public programmeyou rarely have any say over who helps you,what time of day they come, or what they do.But for years people with disabilities have beensaying if I had more control over my personalassistance services, my life would be muchbetter and I could do it for the same amountof money or less. The Cash and CounsellingDemonst ra t ion and Eva lua t ion wereimplemented to test these claims of the disabledcommunities. This presentation will describethis model of consumer-directedness, examinethe research results, summarise how the modelis expanding in the United States and discusssome implementation lessons.

Examples of How to Enhance Quality ofLife of Older People in ResidentialFacilities

Professor Rosalie A Kane

In the United States, traditional nursing homestend to be larger (serving at least 100 residents),somewhat hierarchical in staffing arrangements,and built around routines to help organise thework of a large institution. The Green Houseis a model for a different kind of nursing homein which 10 or fewer people would live in asmall, separate setting, staffed by a dedicatedgroup of care attendants and a visiting team ofprofessionals – a collection of Green Houseswould constitute a licensed nursing home forregulatory and payment purposes. The firstprototype of a Green House was opened inTupelo, Mississippi in 2004. This presentationdescribes the challenges of developing GreenHouses, and the very positive outcomesachieved for residents, their family membersand direct caregiving staff.

Rebalancing Long-term Care: Lessonsfrom the United States Experience

Professor Robert L Kane

Rebalancing implies a need to change theportion of resources expended and personsserved to provide long-term care (LTC). Thehistory of LTC in the US has been developedaround the nursing home, although manyconsumers and experts agree that thisinstitution is not the best way to deliver care.Over the past decade specific efforts have beenmade to redistribute efforts to emphasise morecommunity care. This paper will describe theefforts in eight states to achieve greater balance.The principal theme is that the three centralcomponents of LTC (personal care, housingand medical care) can be delivered in acoordinated fashion that allows recipients tolive as full lives as possible while receivingnecessary services. More progress toward thisgoal has been made with younger persons withdisabilities than with the elderly.

Participation List ofRound-table DiscussionProfessor Denise Burnette

Professor Robert L Kane

Professor Rosalie A Kane

Professor Kevin J Mahoney

Professor Nancy Morrow-Howell

Members from Local Advisory Board

Members from Local Advisory Committee

Cybersenior

Caritas Federation for Senior Citizen

Caritas Jockey Club Integrated Service for Young People

Elderly Council, Hong Kong Christian Service

Elderly Right League (H.K.)

Senior Council, The Hong Kong Society for the Aged

The Intellectuals Association

The Hong Kong Association of Senior Citizens

The Hong Kong Federation of Social Work Students

The Retired Persons’ Association, St. James’ Settlement

The Salvation Army Mutual Aid Society

Sai Kung Tseung Kwan O Senior Concern Group for Medical Services

Participation List ofProject Sharing CornerCaritas – Hong Kong

Christian Family Service Centre

Haven of Hope Christian Service

Hong Kong Chinese Women’s Club Madam Wong Chan Sook YingMemorial Care and Attention Home for the Aged

Hong Kong Christian Service

Hong Kong Lutheran Social Service, Lutheran Church – HK Synod

Hong Kong Sheng Kung Hui Welfare Council

St. James’ Settlement

The Hong Kong Society for the Aged

The Neighbourhood Advice – Action Council

The Salvation Army

Tung Wah Group of Hospitals

Local Advisory Board

Chairman

Mr William Y YiuThe Hong Kong Jockey Club

Members

The Hon Bernard Chan JPThe Hong Kong Council of Social Service

Dr Chan Wai Man JPDepartment of Health

Professor Nelson Chow MBE SBS JPDepartment of Social Work andSocial AdministrationThe University of Hong Kong

Ms Ada FungHousing Department

Dr Leong Che-hung GBS JPElderly Commission

Dr Leung Man Fuk, EdwardHong Kong Association of Gerontology

Professor Terry Lum (Co-Principal Investigator)School of Social Work, University of Minnesota

Professor Ada Mui (Co-Principal Investigator)Columbia University School of Social Work

Mr Paul Tang JPSocial Welfare Department

International AdvisoryCommittee

Professor Barbara BerkmanColumbia University School of Social Work

Professor Iris ChiUniversity of Southern California School ofSocial Work

Professor Rosalie A KaneSchool of Public HealthUniversity of Minnesota

Professor James LubbenBoston College Graduate School of Social Work

Professor John E MorleySaint Louis University School of Medicine

Professor Nancy Morrow-HowellGeorge Warren Brown School of Social WorkWashington University in St. Louis

Ms Bonny WongThe Hong Kong Jockey Club

Dr Vivian WongHospital Authority

Professor Jean Woo (Co-Principal Investigator)Department of Medicine and TherapeuticsThe Chinese University of Hong Kong

Ms Carol YipHealth, Welfare and Food Bureau

Local Advisory Committee

Professor Alfred Chan Cheung Ming BBS JPDepartment of Politics and SociologyLingnan University

Dr Felix Chan Hon WaiThe Hong Kong Geriatrics Society

Ms Maggie ChanCaritas - Hong Kong

Mr Paul ChanHong Kong Lutheran Social Service,Lutheran Church - HK Synod

Professor Sammy Chiu Wai SangDepartment of Social WorkHong Kong Baptist University

Professor Alex KwanDepartment of Applied Social StudiesCity University of Hong Kong

Mr Kwok Lit TungChristian Family Service Centre

Mrs Victoria KwokThe Salvation Army

Mr Michael Lai JPSt. James’ Settlement

Dr Lam Ching Choi JPHaven of Hope Christian Service

The Rev Dorothy Lau JPHong Kong Sheng Kung Hui Welfare Council

Professor Joe Leung JPDepartment of Social Work and Social AdministrationThe University of Hong Kong

Professor Terry Lum (Co-Principal Investigator)School of Social Work, University of Minnesota

Professor Ada Mui (Co-Principal Investigator)Columbia University School of Social Work

Mr Ng Shui Lai BBS MBE JPHong Kong Christian Service

Mr Stephen Ng JPTung Wah Group of Hospitals

Professor Tang Kwong LeungDepartment of Social WorkThe Chinese University of Hong Kong

Mr Tik Chi Yuen JPThe Hong Kong Society for the Aged

Mr Tung Chi FatThe Neighbourhood Advice – Action Council

Ms Anita Wong Yiu-ming MHHong Kong Chinese Women’s ClubMadam Wong Chan Sook Ying Memorial Careand Attention Home for the Aged

Ms Bonny WongThe Hong Kong Jockey Club

Professor Jean Woo (Co-Principal Investigator)Department of Medicine and TherapeuticsThe Chinese University of Hong Kong

Dr Loretta Yam Yin-chun BBSPamela Youde Nethersole Eastern Hospital

Professor Angelina Yuen JPDepartment of Applied Social SciencesThe Hong Kong Polytechnic University