Taiwan Today

The Long-term Care Plan 2.0 aims to create a comprehensive integrated care system that will allow the elderly and disabled to live with dignity in their communities.

On weekends, dementia patient Liu Rong-fang (劉榮芳) rarely leaves the couch in his living room, lingering in his favored spot as day turns to night. It is a very different story Monday through Friday, when a minibus from the nearby Wei Ai Lun day care center picks up the 73-year-old in the morning and drops him home in the late afternoon.

During the eight hours in between, Liu is cared for, encouraged to participate in group activities and, perhaps most importantly, met with understanding about his condition. And for all this, patients or their families pay at most NT$8,500 (US$265) per month.

“My children are out working and my wife is often busy. That’s why I don’t do anything when I’m at home,” said the septuagenarian, whose memory of recent events is often hazy while recollections from his younger years remain strong. “But since I started going to the day care center, my life has been fun and filled with exercise and group activities.”

Wei Ai Lun, a privately run facility for seniors with dementia in central Taiwan’s Changhua City, is among scores of centers across the nation participating in the government’s Long-term Care Plan 2.0. The 10-year initiative aims to establish a comprehensive care system that promotes aging in place—the ability to live safely and independently in one’s home or community regardless of age, ability or income level.

Trial services under the program were launched last year in 20 cities and counties. Pilot centers such as Wei Ai Lun are referred patients by local authorities, with the cost of related care either partially or fully subsidized by the government depending on an individual’s financial status.

“The Long-term Care Plan 2.0 will further facilitate the integration of services and increase the number of long-term care providers based on local needs,” said Chien Hui-jiuan (簡慧娟), director of the Social and Family Affairs Administration (SFAA) under the Ministry of Health and Welfare (MOHW). “This holistic approach will involve the participation of long-term care, medical and community-oriented facilities.”

Demographic Challenges

Taiwan’s population is aging rapidly owing to rising life expectancies and low birthrates. The country will likely become an aged society in 2018, when about 14.5 percent of the population is expected to be 65 or older.

To meet this demographic challenge, the Cabinet approved the Long-term Care Plan 2.0 in September last year. It marks a major expansion from the first-generation program rolled out in 2007, boosting coverage to include disabled persons under the age of 49, people with mild dementia over 50, disabled indigenous residents over 55 who live in low-lying areas and infirm seniors over 65.

With the changes, the number of eligible care recipients is expected to increase from roughly 511,000 to 738,000. “Our goal is to foster private sector investment in creating a responsive care services network,” Chien said.

Under the plan, the government will promote the establishment of a nationwide system comprising thousands of long-term care centers within four years. These facilities will be categorized into three tiers. The Tier A, or flagship, centers will serve as community-based integrated service facilities. One or more of these will be set up in every township, village and city in Taiwan depending on local population size.

The Tier B centers, such as Wei Ai Lun, are likened by the MOHW to “specialty stores.” Ultimately, the ministry aims to establish one of these facilities in every junior high school catchment area. The Tier C centers, described as serving like “corner stores,” will offer services to nearby residents, with the government planning to set up one such facility for every one to three wards.

In essence, the Tier A centers will serve as the first contact windows for applicants, assessing their specific needs, while the Tier B and C centers will be in charge of delivering services such as barrier-free home modifications, day care, meal delivery, nutrition counseling, rehabilitation and transportation. A total of 17 Tier A, 44 Tier B and 85 Tier C service centers are operating under the trial program.

Boosting Utilization

Chen Ya-mei (陳雅美‬), a professor in the Department of Public Health at National Taiwan University (NTU) in Taipei City and expert in long-term care development, said that the first-generation program did a good job of setting up an initial long-term care infrastructure. However, it had a major shortcoming in the form of low utilization rates resulting from the fact that many family members of long-term care patients did not know how to apply, she added.

“Only around 35 percent of eligible patients received services under the first-generation initiative,” the professor said. “So, the new plan places considerable emphasis on disseminating information.”

Another primary goal is to cultivate a new generation of industry professionals. “The program aims to foster employment by encouraging long-term care providers to boost the availability of in-home services and expand career opportunities for young people, new immigrants and experienced workers,” SFAA Director Chien said.

According to NTU’s Chen, the first- and second-generation plans have helped draw university graduates to the sector. “The pilot stage of the 2.0 program seeks to cultivate better salary structures. And what we’re seeing so far is that the general shift from hourly to monthly pay is helping improve perspectives of the industry among younger job seekers,” she said.

The professor’s observations are echoed by the Hondao Senior Citizen’s Welfare Foundation, one of Taiwan’s most prominent nongovernmental senior care organizations. Hondao is participating in the trial launch of the Long-term Care Plan 2.0, operating a Tier B facility in New Taipei City’s Xinzhuang District.

Chen Huan-yu (陳奐宇), the foundation’s New Taipei City district director, said that the sector’s conventional hourly pay schemes essentially prevented younger people from viewing long-term care as a viable career option. This in turn led to serious labor shortages and the current situation in which many families rely on foreign workers for in-home care services. With a view to addressing this, “Hondao has developed a stable monthly salary system and a career promotion pipeline involving training and job rotation,” Chen said.

Funding Amendments

According to MOHW estimates, the Long-term Care Plan 2.0 will require funding of almost NT$16.2 billion (US$509.4 million) this year, more than three times the 2016 long-term care budget of NT$5.3 billion (US$166.7 million). To help finance this increase, the Legislative Yuan approved Jan. 12 amendments to the 2015 Long-term Care Services Act that levy an additional duty on tobacco and increase gift and inheritance taxes.

Scheduled to take effect June 3, the amendments will raise the duty on cigarettes by NT$20 (US$0.63) per pack and increase the tax on inherited assets from a flat rate of 10 percent to a variable rate of between 10 and 20 percent.

John Marrett, lead Taiwan analyst for London-based think tank the Economist Intelligence Unit, is optimistic regarding the funding amendments. “The risks of inadequate tax collection are higher with an inheritance tax compared to say goods and services taxes,” he said. “Fortunately, the government has pledged to cover most of the program’s cost with a hike in tobacco duties, a safe bet in fiscal terms.”

Back at Wei Ai Lun in Changhua, Liu and about three dozen other beneficiaries of the trial services are participating in their first memory training exercises of the day. Later in the afternoon, a group of elementary school students will visit the center to entertain the seniors with a play.

“The positive effects of community-based care, which the Long-term Care Plan 2.0 seeks to promote, are clear to us as the local dementia sufferers who come to the center are drastically different from those who don’t,” said Ji Ciao-ping (紀巧屏), head nurse at Wei Ai Lun. “We help them feel happier and healthier, so there is often no need for their families to move them to residential care.”

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Copyright © 2017 by Jens Kastner