Transcript 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

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

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
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.
 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
25
20
20.07
15
14.08
10
5
0
Old age(over 65)
population (million)
7.1
1.47
1993
Percentage in all
population (%)
8.93
2.04
2001
3.54
2020
5.17
2031
year
(Ministry of Interior of Taiwan, 2003)
Changes of old age over 65
in Asian countries
20
18
18
17.3
16.2
16
15.1
14.1
14
12
13.1
Taiwan
%
Japan
10
South Korean
8
6
6.8
5.9
5.7
5.4
7.4
6.1
6
5.7
7.9
6.9
6.4
6.1
8.3
7.4
6.6
8.6
8.8
7.2
6.8
7.6
7.1
7
Singapore
China
4
2
0
1992
1994
1996
1998
2000
2001
Year
(Ministry of Interior of Taiwan, 2003)
Changes of old age over 65
in six countries
30
27.4
percent (%)
25
20
15
10
5
0
12.5
12.1
9.5
6.3
2.6
1965
15.6
14
11.3
9.1
15.2
14.9
14.5
12.6
17.2
16
15.7
12.4
7.5
8.4
22.9
21.3
18.1
16.6
1995
Japan
Germany
France
UK
USA
4.2
1980
Taiwan
2000
2025
year
(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
3.0:1
Current Community Care Services
A. Homecare Service
B. Day Care Service
1. Housework
C. Continue Education
Programs
Service
Cooking, laundry, cleaning, grocery shopping
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)
Home Care
Service
year
Day Care
Service
Elderly
Volunteer
Service
Elderly Continue
Education Program
Number of
Number of
service
Number of
older
times
Number
Number of
service
people
Number Number
Number
Number (counted
times
of
Older
(includes
of
of
of the
by the
(counted
Education
People
of clients
temporary
Teams Volunteer
programs
service
Centers
Enrollment
by the day
care from
item from
from 2000)
2000)
2000)
1996
...
165,297
...
197,086
58
2,495
302
1,849
60,320
1997
...
193,221
...
256,132
47
2,564
220
1,995
74,976
1998
...
294,645
...
314,358
76
3,897
255
2,068
77,886
1999
7,064
580,870
974
176,659
91
3,666
241
2,364
79,807
2000
8,194
699,724
1,375
215,393
164
5,779
303
2,818
93,244
Elderly Welfare Service in Taiwan (1996~2000)
Elderly
Elderly
Welfare
Community
Services
Hotlines
Clubs
Center
Elderly Protection
Abandoned
Abused
Neglected
year
Number of Number Number of Number of
the Clients of times Clients
Clients
Number
Number of Number of Number of Number of
Number
of
Old
times
Old
times
of Times
Hotlines
People (Services) People (Services)
Number of
Old People
Number of
Times
(Services)
1996
213
...
3,442
...
24
5,994
...
...
...
...
...
...
1997
246
...
3,480
...
152
6,923
...
...
...
...
...
...
1998
249
...
3,893
...
45 33,785
...
...
...
...
...
...
1999
258 2,803,487
3,940
1,645,211
9,452
140
1,119
260
1,190
649
2,602
2000
259 2,625,955
3,899
1,736,429
65 27,857
121
1,446
190
744
393
1,603
167
Elderly Welfare Service in Taiwan (1996~2000)
Number of Older
People Receiving
Elderly Housing
Improvement
Meal Services
Year
1996
Number of Older
People
Number of Times
(Services)
...
118,128
800
...
195,753
760
...
33,593
767
5,419
802,825
493
9,360
1,351,431
1,124
1997
1998
1999
2000
(Ministry of Interior, 2003)
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
 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
 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
 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.
 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
Intervie
w
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
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
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
 Social Worker Homevisit
Findings
Social Work Association
Assess applicants
for homecare
service
Administration
Division
Local Government
Clarify
service
area and
process
Other Homecare
Service Support
Centers
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
Service promotion
Case referral
Case
referral
Palliative Care
Ward
Discharge Planning
Committee
Ward station
Hospital
Homecare Support Service Centre in Hospital
Social Welfare Foundation in Hwalien
Case referral
Resource sharing
Long-Term Care Center
Local Government
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
Homecare
service
IT Company
Welfare Foundation
Social workers refer
cases/resource connection
OT/PT for clients with
stoke
Meal
delivery
Emergency
support
Case referral
Emergency
notifying service
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.
Social
worker
Doctor
Homecare
supervisor
Nurse
Learning professional
knowledge from each
other will enhance
communication and
increase resources sharing.
OT
Clerk
HomeDietician
carer
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
Volunteers agencies Groups
Police
office
Public
Health
Centre
Fire Bureau
Transportation
Local/Central Government
Dep. of
Health/
Central
Government
 Older people receiving
homecare service in
Chung-Hwa county