Taiwan is facing a social time bomb as its population ages. In response, through the recent passage of the Long-term Care Act 2.0, it is dramatically ramping up spending on its elderly population. But critics question how the Tsai administration intends to pay for long-term care, and ask what the implications are for the future.
Seventy-year-old retiree Lin Taitai is part of the fastest growing demographic in Taiwan – the elderly, who now account for some 13% of the population but will likely reach 20% by 2025, bringing Taiwan into the ranks of the “super-aged” societies.
Yet the retired septuagenarian is healthy and active, keeping a schedule of activities ranging from dance classes to volunteering to care for grandchildren that would exhaust people one-third her age. With a wide network of friends and family and benefiting from many government-sponsored community programs aimed at keeping the elderly engaged and healthy, Lin represents the best side of growing older in Taiwan.
Chang Taitai, 88, experiences old age in a very different way. Physically frail, with some degree of dementia and relying solely on the care of a daughter who is in the midst of an active career, Chang is largely isolated in her home, cared for by a foreign worker who has only a rudimentary understanding of Chinese and is unable to take her to community activities.
Further, Chang’s daughter notes that none of the caregivers offered by various nonprofit organizations has been sufficiently trained to deal with the level of disability involved (requiring assistance with toileting, for example), rendering them effectively useless. Forced to leave an assisted living center in her home city of Taichung after her care needs exceeded the center’s capacity, Chang is lonely and isolated in Taipei, and presents a considerable burden on her daughter both in terms of caregiving and finances.
These two women are in many ways emblematic of the hopes and challenges surrounding Taiwan’s efforts to provide long-term care to its growing elderly population.
Last November, Taiwan launched its Long Term Care 2.0, an amended version of the Long Term Care Act passed in 2015 to replace legislation enacted in 2008 under the Chen Shui-bian administration. LTC 2.0 greatly expands the array of services provided by the government to care for the elderly, as well as widening the scope of people capable of receiving these services. Budgets have been significantly bolstered to fund the needs of the elderly.
Yet Taiwan faces significant hurdles in bringing its long-term care to the level needed by much of its population. Training for caregivers is widely conceded to be inadequate in preparing workers for the intense physical realities of toileting, safely lifting seniors in and out of public transportation, and otherwise navigating the complex terrain of Taiwan’s cities. Critics maintain that the expanded scope of services includes redundancies, and that Taiwan still fails to provide the necessary services for the most vulnerable portion of the population.
The original LTC was debated in the Executive Yuan and the legislature for around seven years before it was passed, and implementation did not begin until January 2008. With an average annual budget of NT$3.3 billion (around US$100 million), the initial LTC covered people suffering from age-related disability over 65 years old, “mountain aboriginals over 55 years of age,” disabled persons over 50 years of age, and elderly people living alone, according to documents supplied by the Ministry of Health and Welfare (MOHW).
For these individuals, LTC offered such types of care as home nursing, home and community-centered rehabilitation, subsidies for rent and other living costs, and transportation services. The services were provided through nonprofit organizations (NPOs) under contract from local health and welfare departments using funding from the central government.
LTC 2.0, developed by the Tsai administration and passed by the Legislative Yuan in September 2016, employs a much larger budget of NT$20 billion to greatly expand both the number of people eligible for assistance and the kinds of aid available. Now added to coverage by the LTC 2.0 are people over the age of 65 with dementia, “disabled lowland aboriginals between 55 and 64 years of age,” disabled people under 49 years of age, and the frail elderly.
The number of services has been increased by nine for a total of 17 items. Among the new categories are dementia care, family-care support, community-based preventive care, integrated services for aboriginal groups in remote areas, and hospital discharge plans and transition care.
“The dramatic change in the demographic structure is quite a new challenge not only for Taiwan but for a lot of the world,” says Tsay Shwu-feng, director-general of MOHW’s Department of Nursing and Health Care. “Behind the structural population changes, there is a lot of work to do.”
The changes to elder care in Taiwan are aimed at easing the burden for more seniors and their families while generating greater efficiencies in service delivery and leveraging Taiwan’s cultural characteristics, including the desire for senior citizens to be cared for within the family. Tsay says that the revisions in the LTC 2.0 combine traditional views of elder care with nearly a decade of experience with the original LTC, as well as learnings and best practices derived from other countries, particularly Japan.
“We want to develop a Taiwanese model that uses our cultural strengths and reflects our tax and economic situation,” she explains. “By the community, in the community and for the community will be the most efficient way. People know each other and we know what we need. A bottom-up approach, sharing with one another, will help keep costs down and lead to better care.”
Written by Tim Ferry
To read the article: https://topics.amcham.com.tw/2017/03/caring-taiwans-elderly/
