In the News

Taiwan's aging society raises questions on long-term care

Women and foreign caregivers are heavily relied upon in Taiwan’s long-term care scene. (Staff photo/Huang Chung-hsin)

• Publication Date：03/25/2011
• Source： Taiwan Today
• By  June Tsai

The news that an 84-year-old man killed his bedridden wife last year sent shock waves through Taiwanese society. The man, who had trouble finding caregivers for his Parkinson’s disease-stricken wife, told police he could not stand to watch her suffer anymore. His story highlights a crucial issue for Taiwan—the need for a viable long-term care system.

According to official statistics, 2.47 million people, more than 10 percent of the population, were above age 65 at the end of 2010. With the world’s lowest birthrate, Taiwan will become an aged society by 2014, when 14 percent of the country’s people are seniors. This figure is expected to reach 20 percent by 2025.

“It will take Taiwan just eight years to grow from an aged to a super-aged society, which is one third of the time it has taken to grow from an aging society to an aged one,” said Teng Sue-wen, director-general of the Department of Health’s Bureau of Nursing and Health Service Development.

Also, an estimated 245,000 people, or 10 percent of the senior population, as well as 117,000 seriously disabled citizens, require long-term care, defined in Taiwan as care given to those who require assistance with the activities of daily living for a period of six consecutive months.

In 2002, to cope with an aging population, the government began setting up local long-term care centers throughout the country and piloted a management system for them, Teng said. These measures were followed with the commencement of a 10-year long-term care program, the country’s first comprehensive care initiative, in 2008.

To help incapacitated citizens “age at home,” the program, according to the DOH, aims to make care services available to all, offer support to family caretakers, build a care management system and develop human resources, service options and a financial framework.

The program offers a variety of service options to meet particular needs, including home and community-based care, respite care, transportation and meal services, as well as institutional care.

In practice, however, in the two years since it was implemented, only around 10 percent of potential recipients have requested long-term government services. “There are too few services, and they are not flexible or trustworthy enough,” said Tseng Chao-yuan, a spokeswoman for Long-term Care Watch, an umbrella organization founded in 2010 to examine the government’s care policy.

“Many applicants complain that they have real needs but do not meet the official qualifications, or no services are available for them even when they are qualified. Bureaucratic attitudes at all levels are to blame,” she said.

The low usage rate led to cuts in the program’s budget last year. LCW argued that the cuts hamper the program’s ability to deliver results.

Acknowledging the less than satisfactory performance, Teng argued that the absolute age and degree of incapacitation of the recipient need to be taken into account, as well as the financial situation of the household, given that the scheme is paid for with tax dollars.

“Actually, applications for services have been growing in recent months, and the problem for the government now is how to provide the qualified caregivers that are needed,” she said.

The DOH is mulling an act regulating the provision of care professionals and the establishment and management of long-term care institutions, Teng noted. The bill, awaiting approval from the Executive Yuan, would pave the way for the creation of a national long-term care insurance system.

The proposed act, integrating existing laws on the care and welfare of senior and disabled citizens, is meant to ensure the equal distribution of long-term care resources throughout the country and make services truly accessible to all, according to Teng.

“Under this legislation, long-term care giving will be recognized as a profession, and its quality enhanced through a certification, assessment and registration system,” she said.

Having examined the bill, however, Tseng of LCW doubts it could really help generate enough qualified professionals.

She said the bill seems to be more about institutionalizing care services than mapping out the future of Taiwan’s long-term care system.

It fails to address important issues such as the need for a continual supply of manpower and the overreliance on foreign labor, she said.

“To effectively solve the issues, the original 10-year care program must be carried through to completion, so that there will be sufficient data for analysis to contribute to the eventual construction of a comprehensive long-term care system,” said Lin Wan-i, professor of social work at National Taiwan University and principal architect of the 10-year plan when he was a minister without portfolio.

An important part of the plan, Lin said, is to fill the human resources gap through formal education as well as job training. Under the program, the coverage of professions ranges from social workers, various therapists to case managers and supervisors.

“Only with a sufficient number of professionals and a body of practical experience can a law regulating care services be relevant,” Lin said.

In Taiwan at present, only 72,000 seniors, or one third of those receiving long-term care, live in nursing institutions. The rest receive home care, provided by family members, along with some 170,000 foreign caregivers.

The draft act does not touch upon the issue of foreign labor at all, Lin said. “To implement a workable local care system, Taiwan’s reliance on foreign caregivers has to be reduced, so the country’s labor laws must also be reckoned with when drafting a long-term care act,” he said.

For the Taiwan Association of Family Caregivers, glaringly absent from the draft is a scheme to provide support for informal caregivers.

According to TAFC surveys, 80 percent of family caregivers are women, and 50 percent of them are over 50 years of age. They spend an average of 13.55 hours a day taking care of a relative, and more than half exhibit a tendency to depression.

“Very soon Taiwan will see elderly people having to care for their even older family members, and women, who have traditionally played the role of care provider, shouldering the task of caring for other aged women, with their relatively longer life expectancy,” said Chien Hsi-ju, TAFC secretary-general.

Noting that current policy debate has focused on whether Taiwan should adopt a tax-funded long-term care system or an insurance system, the TAFC has argued that a sustainable care system must start from the perspective of caregivers.

“The dilemma for families that need care services is that they either have to pay for foreign labor, or when money is short, one family member must shoulder the year-round task of providing care while sacrificing any aspirations of her own,” Chien said.

“We expect the government to help share the burden,” she said.

The importance of multiple service options, respite care services, care education and health consultations for caregivers cannot be ignored in crafting a care system, she stressed. “Otherwise, more tragedies will occur soon.” (THN)

Write to June Tsai at june@mail.gio.gov.tw