The Siu Lam Integrated Rehabilitation Services Complex (SLIRSC), established by Hong Kong's Social Welfare Department (SWD) and situated in Tuen Mun, is the city's largest purpose-built rehabilitation facility, providing 1,150 residential placements and 560 day training places for individuals with mental, intellectual, and physical disabilities. Managed by three NGOs-SAHK, Tung Wah Group of Hospitals, and New Life Psychiatric Rehabilitation Association-it fulfills a 2013 policy initiative to expand care for disabled persons. As of March 2025, SLIRSC serves 751 residents. A large proportion of the residents are elderly with multiple chronic conditions, requiring frequent follow-ups at SOPCs and GOPCs. Mobility issues further complicate transportation to clinics, while managing infections in a large residential environment poses additional risks. All these challenges call for a tailor-made Medical-Social Collaboration model.
Overseen by a Committee led by the Cluster Chief Executive of New Territories West Cluster of Hospital Authority and Assistant Director of SWD, this collaboration integrates health and social services with three goals: streamline care delivery, enhance quality, and improve efficiency. Key strategies include reserving clinic quotas for SLIRSC residents, enhancing telehealth for follow-ups at GOPCs and SOPCs, and establishing outbreak management protocols. These efforts have led to improved access to care and effective management of COVID-19 outbreaks. The model also focuses on staff training and specialised health interventions, such as successful MRSA decolonisation therapy, to enhance the quality of service. Medication management was also streamlined by electronic transfer of dispensing data, reducing errors and saving time.
The Medical-Social Collaboration model at SLIRSC emphasises partnerships between healthcare providers and social services to enhances access, care quality, and resource use for a complex population. Early outcomes are encouraging, with continuous refinements and collaboration aiming to strengthen holistic care in residential care homes in Hong Kong.
