Taiwan Today

When Xu Mei-jiao (許美嬌) reminisces about her childhood in northern Taiwan’s Hsinchu County, her thoughts invariably turn to her grandparents. Her father’s parents played a central role in her upbringing, raising her with affection and patience when her father and mother left the family home for several years to work in the nation’s cities. As she grew older, as is so often the case, the roles of caregiver and care recipient reversed. After her grandmother passed away, Xu, then a junior high school student, helped look after her increasingly frail grandfather. Far from viewing this as a burden, she felt a sense of contentment in returning the kindness that her relative had previously shown her.

Inspired by the happy times she shared with her beloved grandparents, Xu later pursued a career as a caregiver for disabled or incapacitated older people such as those suffering from Alzheimer’s disease or in persistent vegetative states. “Caring for the elderly reminds me of the time I spent with my grandparents,” she explained in a guidebook on home care services published by the Federation for the Welfare of the Elderly (FWE). “I’m so grateful to them, and actually feel deep regret that I didn’t have the opportunity to look after my grandmother.” Last year, Xu, who works for the Hsinchu Catholic Social Service Center, was named one of the nation’s top 10 home caregivers by the Taiwan Home Service Strategic Alliance (THSSA) in recognition of her two decades of tireless dedication to her job.

The importance of elderly care professionals such as Xu has come into sharp focus in recent years in light of the nation’s unprecedented demographic challenges. Taiwan has a rapidly aging population, a problem aggravated by one of the world’s lowest birthrates. As of the end of June this year, the country was home to 2.87 million people aged 65 or older, comprising more than 12 percent of the population. The proportion of senior citizens in the country will soon pass the 14 percent threshold deemed by the U.N. to denote an aged society. According to projections from the Cabinet-level National Development Council (NDC), the ratio will rise to more than 20 percent by 2025, and reach 40 percent by around 2060.

Teng Su-wen (鄧素文), director-general of the Department of Nursing and Health Care under the Ministry of Health and Welfare (MOHW), notes that countries around the world, and especially developed nations including many member states of the Organisation for Economic Co-operation and Development, are facing unparalleled social challenges as the postwar baby boomer generation reaches retirement age. “An aging population means more people in need of care, while low birthrates mean fewer people to offer that care,” she says. “Taiwan faces one of the world’s severest challenges in this regard.”

According to MOHW statistics, 16.4 percent of Taiwan’s senior citizens, totaling approximately 470,000 people, currently require long-term care. This figure is certain to increase substantially in the coming years.

The nation’s aging population has led to the emergence of numerous elderly care groups in recent decades. Founded in 2010, the THSSA, an association of more than 30 home care providers located throughout the country, grew out of an alliance of 10 such organizations in northern Taiwan, among them Xu’s Hsinchu center. The alliance was created at the request of the FWE with the goal of promoting greater coordination among elderly care groups.

Wu Yu-chin (吳玉琴), secretary-general of the FWE, which was established in 1994 and now consists of more than 100 senior citizens associations across the nation, stresses that caregivers require specialist knowledge and training. For one thing, “dementia can cause a variety of physical and psychiatric changes, so patients can have widely different needs,” she says.

In addition to skilled manpower, Taiwan will require an efficient elderly care network that provides people with information about and easy access to home care services, day-care centers, and state and privately run nursing facilities, Teng says. Recognizing this, the Cabinet launched a 10-year program in 2008 to transform the nation’s long-term care system. This plan, now overseen by the MOHW, has led to the implementation of Taiwan’s first national-level long-term care network for disabled and incapacitated citizens, of whom more than 60 percent are aged 65 and older.

In the past, such services were offered “on a smaller scale and by various government agencies through individual programs,” Teng notes. For instance, a business development initiative for long-term care services was launched in 2002 by the Cabinet-level Council for Economic Planning and Development (CEPD), which merged with the Research, Development and Evaluation Commission in 2014 to form the NDC.

“That program was aimed at boosting employment among caregivers,” Wu recalls. As part of the project, the CEPD introduced subsidies for home care services for disabled people from moderate-income households, in contrast to previous welfare programs, which exclusively targeted low-income families.

This was a major move toward universal care coverage for disabled and incapacitated citizens, Wu notes. However, until recently, “care services initiatives such as this were managed separately by various health, welfare or business development authorities without efficient collaboration between them,” she adds.

The government’s 10-year program brought all such initiatives under the administration of the MOHW. Furthermore, the ministry has established a long-term care management center in each of Taiwan’s special municipalities, county-level cities and counties. “Through the implementation of this single-window system, people can get access to all the government’s care services in one place,” explains Chang Chia-chi (張佳琪), director of the School of Gerontology Health Management at Taipei Medical University.

Additionally, she notes, the centers send long-term care management specialists to applicants’ homes to assess their needs and offer suggestions regarding the best service options. These specialists also work with patients and their families to offer viable alternatives to long-term institutional care. Chang says such efforts are in line with modern care concepts, which emphasize in-home and community-based services rather than extended nursing home stays.

At present, a variety of care options are available under the government’s 10-year initiative, including meal, rehabilitation and transportation programs. Non-medical in-home care, such as that provided by Xu, is the most frequently requested and used service.

In 2008, the Subsidy Regulations on Disabled Senior Citizens Receiving Long-term Care Services were enacted as extensions to the Senior Citizens Welfare Act, promulgated in 1980. Under the rules, local authorities pay 70, 90 or 100 percent of the NT$200 (US$6.45) hourly cost of home care services from accredited providers based on applicants’ financial status.

Subsidy recipients can apply for 25, 50 or 90 hours of in-home care per month depending on the severity of their disabilities, which is determined by the degree of difficulty they have conducting everyday activities such as eating, dressing, walking and using the bathroom. “These services have been well received by people with disabled family members,” Wu notes.

Through the 10-year program and related initiatives, the government has also set a target of opening at least one day-care center for the elderly in each of the nation’s 368 townships, urban districts and county-administered cities. To date, such facilities have been set up in around half of these areas. Largely due to the establishment of the centers and the expansion in subsidies for in-home care, the number of elderly people benefiting from government-supported long-term care services has increased significantly from around 9,000 in 2008 to more than 150,000 today.

Recent government initiatives are part of society-wide efforts to build a comprehensive community-based integrated care system that enables disabled elderly citizens to continue living in their neighborhoods, Wu notes. “Due to inadequate care services in isolated regions, people who work in urban areas tend to move their disabled parents to cities, which is not always a good option for them,” she says.

The new forms of home and community-based services, as well as those at nursing homes, have been enshrined into law in the Long-term Care Services Act. The legislation also regulates the management of long-term care institutions and the employment and training of caregivers, including foreign workers hired by private households, who constitute a large proportion of the nation’s carers. Furthermore, “the act includes funding for services that prevent disabilities from worsening,” Wu notes.

The Long-term Care Services Act was promulgated in June this year and will come into effect in mid-2017, possibly in conjunction with the Long-term Care Insurance Act, a draft of which was approved by the Cabinet in June. The insurance plan, which is similar to Taiwan’s National Health Insurance program, would require all citizens to pay premiums that would then be used to cover long-term care services for and provide funds to disabled and incapacitated citizens.

Many experts and scholars like Chang welcome the prospect of universal coverage for long-term care services. Still, the operation of such a system will depend on the development of efficient care networks as well as sufficient personnel, which Chang’s school and other similar departments in the academic and vocational education systems are working to supply. “I often tell my students,” she says, “that their work will be one of the crucial factors in determining the future of Taiwan.”

Write to Pat Gao at cjkao@mofa.gov.tw