Community Care Services for Older People in Taiwan

Community Care Services for Older People in Taiwan University of Bath Social and Policy Sciences Dept. Ph. D student Ju-Huey Wen

Taiwan Location n Eastern Asia Islands bordering the East China Sea, Philippine Sea, South China Sea, and Taiwan Strait North of the Philippines Off the southeastern coast of Mainland China n Population nearly 23 million § GNP US $ 12, 876 (2002) § Economic structure 1950 Agricultural exports 1960 s & 70 s Light manufacturing 1980 s & 90 s High technology and chemical product exports 1995~ Technology-intensive products

Chronology 1624 Dutch & Spanish colonized Taiwan 1662 Jheng Cheng-gong defeats Dutch forces, ending Dutch rule in Taiwan. 1684 Manchus replace the Jheng family as the new rulers of Taiwan. 1895 The Treaty of Shimonoseki concludes Sino-Japanese War; Taiwan is ceded to Japan. 1945 Taiwan is retroceded to China after 50 years of Japanese occupation. 1947 Due to bad administration, ethnic tension, and other factors, an islandwide uprising, known as the February 28 Incident, breaks out. 1949 The central government of the Republic of China relocates to Taiwan, after the mainland falls to the Communists. 1996 The first direct presidential election is held. 2000 Democratic Progressive Party candidate Chen Shui-bian is elected president of the Republic of China, ending the KMT's 50 -year hold on the presidency in Taiwan.

Welfare Policies • The Constitution Social security should include employment policy, social insurance, social relief, medical services, national health insurance, and women, disabled, and aboriginal Taiwanese welfare policies. w Senior Citizen’s Welfare Law established in 1980 and then amended in 1997. • Intensive Elderly Care Service Project 1998 provide various services for older people in the communities, including homecare service, day-care centers, medical services, and elderly residential plans. • Guidelines and Action Plans for Service Industry Development Medical, health care & care-giving services 2004 Care services: Inpatient care, home care, community day care centers, Alzheimer's patient centers, etc. Senior citizens’ housing: Housing for the elderly and other related industries, including transportation, tourism, trusts, entertainment, and insurance.

Increasing Old Age in Taiwan (Ministry of Interior of Taiwan, 2003)

Changes of old age over 65 in Asian countries (Ministry of Interior of Taiwan, 2003)

Changes of old age over 65 in six countries (Da-Ho Liu, 2001)

Old age population dependency ration/working and retired population ration in six countries Country 1995 Age(%) Old age population dependency Ration (%) 20~64 65+ Taiwan 59. 1 7. 5 12. 7 Japan 62. 7 14. 5 Germany 63. 3 France 2025 Working population: Retired population (%) Age(%) Old age population dependency Ration (%) Working population: Retired population (%) 20~64 65+ 7. 9: 1 63. 0 16. 5 26. 2 3. 8: 1 23. 1 4. 3: 1 55. 4 27. 4 49. 5 2. 0: 1 15. 2 24. 0 4. 2: 1 58. 8 22. 9 38. 9 2. 6: 1 59. 0 14. 9 25. 3 4. 0: 1 56. 4 21. 3 37. 8 2. 6: 1 UK 58. 8 15. 5 26. 4 3. 8: 1 52. 5 19. 0 36. 2 2. 8: 1 USA 58. 1 12. 6 21. 7 4. 6: 1 54. 8 18. 1 33. 0: 1

Current Community Care Services A. Homecare Service B. Day Care Service 1. Housework Service Cooking, laundry, cleaning, grocery shopping C. Continue Education Programs 2. Paperwork Service D. Recreation Centers Apply welfare services, pay bill, write letters for clients, help them read books or news. 3. Medical Service E. Hotline Service Accompany older people to see a doctor, help them take medicine and take simple exercise 4. Emotional Support Service F. Meal on Wheels Service Talk to older people, emotional support, care about their health and lives, phone service 5. Leisure Service Accompany older people to visit friends, attend activities, go for a walk. H. Physical Examination

Elderly Welfare Service in Taiwan (1996~2000)

Elderly Welfare Service in Taiwan (1996~2000)

Elderly Welfare Service in Taiwan (1996~2000) (Ministry of Interior, 2003)

Current Problems w Lack of a welfare resource system support families with elderly members w. Administration problems w Fragmented community care services w Lack of the quality management of social services

w Lack of a welfare resource system support families with elderly members Decrease the intention to take care of elderly members Difficulties in accessing welfare resources Welfare resources are centralized in the urban areas

w Administration problems Five categories of institutions: Elderly accommodation institution-Ministry of Health Nursing home Elderly community shelter Elderly continuing education programs Social service agencies Ministry of Interior

w Fragmented community care services Social services overlap in some areas. Some communities do not have enough resources to provide social services. A lack of communication among different professional workers.

w Lack of the quality management of social services Some private welfare agencies provide services based on the spirit of charity. Three hundred and twenty-eight nursing home are still running illegally. Lack of a standard assessment and a monitoring system.

Research Aim Establish an integrated community care model to improve these problems. Research Questions §Lack of coordination Does a lack of coordination among service providers cause duplication, oversupply, or insufficient services for older people? §An integrated community care service model What are the essential resources for establishing an integrated community care services for older people? §Quality control of community care service How can the quality of services which provided by multiprofessional teamwork be evaluated? §The outcome of an integrated community care service model How does an integrated service model meet the needs of older people and solve current problems?

Sampling Four locations, including both rural and urban areas, were chosen by the level of urbanization and their locations in Taiwan. (1) Wan-Han Elderly Service Centre in Taipei city, (2) Ann-Ping Elderly Service Centre in Tainan city, (3) Mennonite Social Welfare Foundation in Hualien county, (4) Home Care Support Centre in Changhua county.

Data Collection Area Taipei City Chung-Hwa County Hau-Lien County Tainan City Agency Wan-Hua Elderly Service Centre Chunghwa Christian Hospital Mennonite Social Welfare Foundation YMCA Ann-Ping Elderly Service Centre Interview 1. Homecare support and long- term team: 1 director 2 social workers 1 homecare supervisor (social worker) 1 homecarer 1 nurse 1 carer 1. Homecare support team: 1 director (nurse) 2 homecare supervisors (nurse) 1 social worker 1 government administer 1 elderly people 2 homecarers 1. Homecare support team: 1 social worker 1 homecare supervisor (nurse) 1 director 2. Meals on wheels service team: 1 social worker 1 dietician 1 driver 3. Emergency notifying service team: 1 social worker 1 nurse 1 director 1. Homecare support team: 1 social worker 2 homecarers/ supervisors 1 elderly people 2. Day care team: 1 social worker 1 director 1 military service person 1 elderly people Homevisi t Once 13 times One day: 20 old people Once homevisit Once hospital visit Meeting None Twice 1. Team meeting 2. Governmental meeting 3 times Once: Team meeting 1. Team meeting 2. Meals on wheels team meeting 3. Meeting for social worker licence exam

§ Social Worker Homevisit

Findings Social Work Association Clarify service area and process Other Homecare Service Support Centers Assess applicants for homecare service Administration Division Local Government Service promotion Case referral Homecare service supervision Head of Neighborhoods Homecare Supervision Case referral Department of Community Health Case Referral Homecare Service Support Center Department of Social Work Welfare Agencies Case referral Volunteers support Long-term Care Center Case referral Palliative Care Ward Discharge Planning Committee Ward station Hospital Homecare Support Service Centre in Hospital

Social Welfare Foundation in Hwalien Local Government Case referral Resource sharing Long-Term Care Center Administration Division Annual/ monthly report Police Office Head of Neighborhoods Meal provider Case workers Private Hospital (related to the Foundation) Public Health Center Case referral Meals on wheels Service Emergency notifying service Homecare service IT Company Welfare Foundation Social workers refer cases/resource connection OT/PT for clients with stoke Meal delivery Emergency support Case referral/ Financial support Resource sharing Private Welfare Agency Technique support

Coordination §Joint meetings §Understanding the roles of each profession §Clarify duty of each position §Commitment on working together Resources §Government support/Donation/Clients pay for services §Advantage of public agency and religious welfare agency §Informal supports §Volunteers §resource connection system

Quality control §unification of assessment system §Outcome evaluation §Clarify job duties §Continuing training 1. Integrated Community Care Service §Caring responsibility: formal and informal supports §Medical care service at home §Transportation §Diversity of area, culture, and local resource

§Under standing the same level of position, each profession respects each other and works together. §Learning professional knowledge from each other will enhance communication and increase resources sharing.

Local/Central Government Head of neighbourhood/Administration Division Local/ Centre Administration & Supervision of services Families & relatives Informal Government Neighbour care supports hoods Older people Hospitals Health Supports Long-term Care Centre Welfare service Supports Welfare Religion Police Volunteers agencies Groups office Public Health Centre Fire Bureau Transportation Local/Central Government Dep. of Health/ Central Government

§ Older people receiving homecare service in Chung-Hwa county