Community Care Services for Older People in Taiwan

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

2. Location 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 Taiwan • Population nearly 23 million GNP US $ 12,876 (2002) • Economic structure 1950 Agricultural exports 1960s & 70s Light manufacturing 1980s & 90s High technology and chemical product exports 1995~ Technology-intensive products

3. Chronology 1624 Dutch & Spanish colonized Taiwan 1662Jheng Cheng-gong defeats Dutch forces, ending Dutch rule in Taiwan. 1684Manchus replace the Jheng family as the new rulers of Taiwan. 1895 The Treaty of Shimonoseki concludes Sino-Japanese War; Taiwan is ceded to Japan. 1945Taiwan is retroceded to China after 50 years of Japanese occupation. 1947Due to bad administration, ethnic tension, and other factors, an islandwide uprising, known as the February 28 Incident, breaks out. 1949The 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. 2000Democratic 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.

4. 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. • Senior Citizen’s Welfare Law established in 1980 and then amended in 1997. • Intensive Elderly Care Service Project1998 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.

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

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

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

8. Old age population dependency ration/working and retired population ration in six countries

9. Current Community Care Services

10. Elderly Welfare Service in Taiwan (1996~2000)

11. Elderly Welfare Service in Taiwan (1996~2000)

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

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

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

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

16. 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. Fragmented community care services

17. 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.

18. 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?

19. 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.

20. 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 Homevisit Once 13 times One day: 20 old people Once homevisit Once hospital visit Meeting None Twice 1. Team meeting 2. Governmental meeting 3 times • Team meeting • Meals on wheels team meeting • Meeting for social worker licence exam Once: Team meeting Data Collection

21. Social Worker Homevisit

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

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

26. 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

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

28. 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.

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

30. Older people receiving homecare service in Chung-Hwa county