The welfare of the elderly is an issue not likely to go away
as the population continues to age at such a rapid rate.
Benefits for seniors include accommodation, medical
assistance, and subsidies, but more needs to be
accomplished than merely throwing money at the problem.
The United Nations considers a nation to be elderly when 7 percent of its population is over the age of sixty-five. By this standard, Taiwan has been an elderly nation since 1993. The figure increased to 8.4 percent in 1999, which means the island's population is getting old--fast. How fast? The Ministry of the Interior (MOI) expects the number of elderly to exceed 14 percent by 2020. If this happens, it will have taken Taiwan less than twenty-seven years to achieve what the United States accomplished in sixty-three years, and France in over a century. The Council for Economic Planning and Development believes 21.6 percent will be reached by 2036. Only Japan's population is aging more quickly than Taiwan's.
With the enactment of the Welfare Law for the Elderly in 1980, and subsequent revisions, the legal burden of caring for those who are no longer able to care for themselves falls on the shoulders of governments at various levels. Currently, senior citizens who qualify for assistance can receive monthly allowances, pensions, accommodation in state-run retirement homes, and subsidized medical care. But is the state equipped to deal with such a rapidly growing number of graying dependents?
"If the government doesn't address this problem soon, we may pay a dear price in the future," warns Wu Yu-chin, secretary-general of the League of Welfare Improvement for Older People, who has been working with seniors and providing policy recommendations to the government for the last five years. "The Welfare Law for the Elderly is far from complete. Some progress has been made but the revisions were hardly sufficient. Problems in the law will need to be carefully reviewed again."
One of the main issues is the lack of a single authority offering integrated services such as medicine, nursing, and accommodation. The MOI is responsible for the housing of senior citizens while the Department of Health oversees their health care. People are often required to visit one government department after another to receive their benefits. This is made more difficult if a person is suffering from a physical disability, Wu says. "If an elderly person is already living in an institution, why can't the government provide them with complete service at that institution? The last thing an ailing senior citizen needs is to run around from one place to another."
Lee Hsiu-chuan, director of social work for the privately run Creation Social Welfare Foundation, is in full agreement. "To set up a strong private support network, we need cooperation from institutes on all levels. For example, on the weekends we phone a number of elderly individuals who live alone, to make sure they're okay. If we can't get a hold of them, we call the local authorities for help immediately."
What material assistance is available to Taiwan's elderly population? Broadly, it falls into two categories: medical care, and financial subsidies. The details of the various health grants available to senior citizens are complicated and diverse, and only a bare summary will be attempted here. In Taipei and Kaohsiung Cities, each qualified senior is entitled to a maximum subsidy of NT$300,000 (US$9,090) a year in respect of treatment not covered by the national health insurance scheme. Elsewhere the ceiling is the same, except that there is no limit in the case of certain low-income families. There are additional benefits for day-care charges and hospital stays.
Direct financial grants, all funded by the central government, take several forms. In 2000, a low-income elderly person living alone was entitled to receive a monthly subsidy. The amount was set by each local authority. In Taipei City, it was NT$11,625 (US$352); in Kaohsiung City, the other twenty-one cities and counties of Taiwan Province, NT$7,100 (US$215); and on the off shore islands of Kinmen and Matsu, NT$5,900 (US$179).
In addition, certain seniors--not all--are entitled to an extra monthly allowance if they live alone or with their families. The amount varies in accordance with the ratio of the person's income to certain "minimum living expenses" assessed by local authorities. Claimants who live in public institutions, however, are only entitled to a monthly allowance that is fixed islandwide at NT$3,000 (US$91); they receive neither the monthly subsidy nor the monthly allowance.
In the absence of a comprehensive national pension plan, some local authorities have tried to fill the void. Of the ROC's twenty -three cities and counties and two special municipalities, only eight offer benefits to senior citizens who do not receive a private pension or receive any other subsidy from the central government. These programs, while noble, are not always sustainable. Taipei County offered NT$5,000 (US$152) four times a year to those who qualified. In 1999, however, it was forced to suspend its program due to a lack of funds. County officials are now pushing for a national pension plan, a key campaign promise President Chen Shui-bian made to voters.
It may be years before the promise of such a plan is realized, but the government does offer some relief for the aged, says Lee Chun-kuo, director of the MOI's Tienchung Township Retirement Home in Changhua County. The retirement home at which he works houses 362 paying and nonpaying residents. They receive twenty-four-hour care, and they benefit from the home's cooperation with nearby clinics for free or subsidized services such as dental treatment and blood-pressure checks. "The Tsaotun Psychiatric Center, in Tsaotun Township, Nantou County, even offers periodical psychiatric assessments," Lee adds.
One resident, a man identified only as Mr. Huang, is a living testament to the success of the government's retirement home program. "I went hiking this morning with my friends, so I'm late for lunch," he explains. "I've been living here for three years and I've been doing pretty well with the care they've offered me. I think they're doing a good job." The home welcomes underprivileged seniors in need of financial assistance as well as private residents who pay the NT$5,000 monthly fee.
Lee asserts that although many of Taiwan's seniors are from median- and low-income families, most of those who live outside government retirement homes are quite comfortable, given the subsidies they receive. Kuo Hui-ming, vice secretary of Creation Social Welfare Foundation, disagrees. "Money is only one way to address the issue of senior citizens," she says. "What's more important is building a strong social network of support."
Chen Shu-mei, director of social work at the Tienchung Township Retirement Home, has come to the same conclusion. She believes the issue of caring for the elderly is more complex than simply housing them. Because she deals with a variety of people from different backgrounds, problems commonly arise, especially with the publicly assisted residents. These people are often less educated than those who can afford their own care, she explains. Perhaps they have been marginalized in the past and are more inclined to be disruptive than those who have enjoyed greater privileges. It is therefore important to establish a relationship with these people, to discover their problems and work out possible solutions. "If you continue to offer them sincere concern and care, over time, they come around to you," Chen says. "They often just want people to pay attention to their needs, it doesn't matter what sort of background they're from."
Growth in the Number of Elderly
Persons as a Percentage of the Total
National Population
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Source: Ministry of the Interior
The MOI's Lee Chun-kuo agrees that it is necessary to communicate with the home's residents. "This is why I often visit everyone who lives here whenever I have free time," he says. The home also has cooperative programs whereby volunteers come and visit. "It benefits all parties, as senior citizens get a chance to have contact with those in the outside world and people from charity groups and schools get a perspective of what we're doing here," Chen Shu-mei adds.
Another area of concern is senior citizens who have slipped through the cracks of society. "The elderly suffering from mental retardation or other chronic psychological disorders are not adequately provided for by the government," says Li Ching-sung, director of the Elderly Homeless Shelter. There are currently thirty-three elderly homeless people who need to receive psychiatric treatment but remain at the sheltersome have been there for three years--because there are not enough beds in psychiatric institutions, he points out.
"The shortage in the number of beds in public psychiatric wards is a problem caused by patients who should but can't go home," explains Chen Kuai-le, director of the Department of Health's Tsaotun Psychiatric Center. "Families are reluctant to bring their relatives home because of the perceived stigma mental illness carries." An estimated 27 percent of the beds in the island's five psychiatric centers are occupied for this reason.
According to observers, there is no such shortage of beds in regular facilities for the elderly. As of April 2000, Taiwan boasted 54 private and 6 public retirement homes, and 350 registered private nursing homes. "This number appears to satisfy the needs of the elderly," says Wu Yu-chin from the League of Welfare Improvement for Older People. "These resources, combined with community efforts, can go a long way in promoting the welfare of seniors." Lee Hsiu-chuan agrees that community services should play a more important role in the care of the elderly. These services can provide more humane treatment for those who are not in public institutions.
With one in four people in Japan over the age of sixty-five, its government has been under pressure to implement a comprehensive welfare safety net for seniors. In 1989 it launched its "Ten-Year Gold Plan." In 1995 the plan was further revised and was renamed "Gold Plan 21." This comprehensive plan combines health care, employment insurance, and a pension scheme for those over the age of sixty-five. Every sector of the community contributes to this plan. Hospitals, nursing homes, community centers, retirement homes, and other institutions offer their facilities and services at an affordable rate. "Even pharmacies are involved," Wu adds. "A comprehensive welfare system for the elderly is urgently vital for any elderly nation. But Taiwan hasn't even gotten past the debating stage of its national pension plan. So far, the government hasn't done anything or come up with a proposal on this. We're really far behind Japan in this field."
The situation, however, is not completely dire. According to Lee Chun-kuo, the Tienchung Township Retirement Home received NT$90 million (US$2.7 million) from the MOI last year, which was enough to improve the facilities. "Our goal is to provide a healthy environment for the elderly," he says. "We also try to extend our resources to local seniors outside the home."
Some progress has been made in making the government responsible for its less fortunate citizens. In 1999 the amount of money spent on social welfare accounted for 13.7 percent of the central government's budget, or NT$280.5 billion (US$8.5 billion). In 1989 only 5.4 percent of the budget was spent on this.
A decrease in the need for military personnel during peacetime has led the government to make creative use of its excess manpower. Since July 2000, military conscripts can choose to spend their mandatory two years performing social work in either security or social welfare services. "Ten such volunteers are working at our retirement home as consultants or nutrition technicians," Lee says. "They're doing a great job at the home providing companionship and security."
In 2000 the MOI's Department of Conscription drafted 5,000 people for alternative military service. This year 10,000 are expected to join this program. One such conscript is Lee To-ching, a graduate of Chinese Cultural University in labor relations, who has been working at the Tienchung Township Retirement Home for less than a year. "It's been a good experience for me." Lee says. "I've never done anything like this before. It's really taught me to value life and respect the elderly."
Working in welfare services is not always easy or rewarding. "As society changes, community daycare services have become more vital. But it's difficult to get the support of nearby residents," explains Kuo Hui-ming of the Creation Social Welfare Foundation. On December 28, 2000, the foundation's intensive care unit for elderly persons in a coma or vegetative state in Kaohsiung City was forced to close down. "Residents were opposed to the existence of the nursing home in their neighborhood," says Liu Shu-ping, the foundation's public relations officer. "They believed it negatively affected the value of their homes. What's essential is to establish a community network or family-style nursing center for the elderly. But it will take time for people to come around to this idea."
"Civil servants lack the initiative to instigate any new projects," complains Wu Yu-chin from the League of Welfare Improve ment for Older People. "We're always pushing them to go forward. For example, to help people find their elderly relatives who went missing, we established a website to let people know what was happening and offer information on the missing people. This is an ongoing process; we update the data all the time."
Taiwan has yet to devise a comprehensive policy for the care of the elderly. Looking at what the rest of the world is doing in this area, Wu says in the 1960s many European countries rejected the idea of "aging in one place," where people lived and died in large institutions. The trend is toward small community-style services for the elderly, like those found in Japan. Taiwan should likewise strive toward care for the elderly with compassion, but it is ironic to note that as the island grows more prosperous, the need for two incomes in families is forcing it to abandon its once-prized members of society.