Notes on Rehabilitation Services

Notes on Rehabilitation Services

　

Impairment - Any loss or abnormality of psychological, physiological, or anatomical structure of function (e.g. visual impairment, hearing impairment, renal failure, etc.)

Disability - Any restriction or lack of ability (resulting from impairment) to perform our activities in a manner within the range considered normal for a human being (e.g. low intelligence due to mental retardation, not able to hear due to hearing impairment).

Handicap - A disadvantage for a given individual resulting from an impairment or a disability, that limits or prevents the fulfillment of a role that is normal (depending on age, sex and social and cultural factors) for that individual. (e.g. mobility due to physical disability and inaccessibility of public transportation)

Rehabilitation - The process of restoring or compensating the lost/reduced function of a disabled person, whether the disability is congenital or sustained through sickness or injuries in civil, industrial accidents or war, to a condition in which he is able, as early as possible, to lead a normal life, possibly by the use of aids. Rehabilitation is related to functional restoration and their social and economic adjustment.

Government Policy Objective

Rehabilitation services aim to acknowledge the equal rights of people with disabilities to be full members of the community by assisting them in developing their physical, mental and social capabilities to the fullest possible extent and by promoting their integration into the community.

Number of People with disabilities

Autism	3,000
Hearing Impairment	69,700
Mental Handicap	62,000 - 87,000
Mental Illness	50,500
Physical Handicap	103,500
Visual Impairment	73,900
Speech Impairment	18,500
Visceral Disability	882,700

(HKSAR Government, Census and Statistics Department, 2000)

Government Departments and public bodies responsible for services to people with disabilities

Health and Welfare Bureau (The Commission for Rehabilitation is responsible for formulating policies and coordinating various government departments in the implementation of services)
Social Welfare Department (Rehabilitation Programme Plan)
Transport Department (Rehab. Bus)
Education Department (Special Education for children with disabilities aged between 6-15)
Health Department (Child Assessment Centre)
Hospital Authority (Day hospital for discharged psychiatric patients).
Rehabilitation Advisory Committee - an advisory committee appointed by the Government under the Health and Welfare Bureau

Development of Rehabilitation Services in Hong Kong

As compared to other social services, the development of rehabilitation services in Hong Kong is relatively a late phenomenon.
In 1993, the Government has injected 2.3 billions into the Lotteries Fund for the development of elderly and rehabilitation services. As for rehabilitation services, the Government pledged to meet the targets of the then Green Paper on rehabilitation services. Since then, we envisaged a rapid expansion of rehabilitation services.

Expenditure (Million $)	1996-97	2001-2002 (budget)	Increased in 5 years
family welfare service	1,420.40	1,747.00	23.0%
social security	11,545.40	20,684.30	79.2%
elderly services	1,404.70	3,248.00	131.2%
rehabilitation service	1,167.10	2,371.20	103.2%
services for offenders	232.3	286.2	23.2%
community development	221.4	275	24.2%
services for young people	868.5	1,157.00	33.2%
Total Welfare Spending	16,859.80	29,768.70	76.6%
Total Govt Spending (General Revenue Account)	142,127.30	213,954.57	50.5%

Current Issues

Persistent shortfall of services: particularly in terms of residential services. The average waiting time for various residential services is 3-5 years.

Shortage of health professional staff: esp. speech-therapists; occupational therapists, physiotherapists, psychiatrists, psychiatric nurses, educational psychologists, clinical psychologists.

Public prejudice, non-acceptance of & discrimination against the disabled

Insufficient venue for rehab. service premises because of various competing demands for limited premises in public housing estates (esp. due to residents' rejection);

Insufficient involvement of persons with disabilities or their family members in the planning, implementation and evaluation of rehabilitation services.

Unemployment of people with disabilities: One of the debates is whether we should have a statutory quota system for the employment of people with disabilities, i.e. making law to require employers to employ a minimum percentage of people with disabilities, e.g. 1.5%.

Freedom of movement: Do people with disabilities (particularly, physical disability and the visually impairment) freely move around in our community? Issues are related to access to buildings, roads (particularly pavements), and public transportation.

Old Issue – whose responsibility, the family or the society? Say, with more and better residential services, it would be easier for families to “give” up looking after their own members with disabilities. Should we have zero waiting time for residential services? Or, can we have zero waiting time for residential services. Theoretically no unless we provide residential services for all people with disabilities. The shorter the waiting time, then more people will apply. When more people apply, we have to build more to clear the queue.

Carer Support: To reduce the stress of families in looking after their members with disability will reduce the need of institutionalization (i.e. putting the person into a residential institution). Carer support will include – building up social and mutual support group among families, home-based support services (including training, home help services, etc.), resources centres, and respite services (i.e. temporary placing the person with disabilities into a residential home when the carer for some reasons (say ill, travelling, etc.) cannot look after their disabled members).

Service segmentation: Currently, there are different types of services to meet different needs, different types of disabilities, and different age groups. The complex web of services is quite complicated even for a professional, let alone the person with disabilities and their family members.

Lack of integration in the mainstream welfare services: It is difficult for people with disabilities to enjoy other types of social welfare services, such as the children and youth centres. How to maintain the right balance between specialized service and main-streaming (i.e. having the same service for people with or without disabilities) is an issue to be addressed in future development.