Community Care Services for Older People in Taiwan

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Community Care Services for Older People in Taiwan

• University of Bath
• Social and Policy Sciences Dept.
• Ph.D student
• Ju-Huey Wen

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• 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

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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.
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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 Citizens 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.

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Increasing Old Age in Taiwan
(Ministry of Interior of Taiwan, 2003)
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Changes of old age over 65 in Asian countries
(Ministry of Interior of Taiwan, 2003)
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Changes of old age over 65 in six countries
(Da-Ho Liu,2001)
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Old age population dependency ration/working and
retired population ration in six countries
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Current Community Care Services
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Elderly Welfare Service in Taiwan (19962000)
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Elderly Welfare Service in Taiwan (19962000)
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Elderly Welfare Service in Taiwan (19962000)
(Ministry of Interior, 2003)
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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

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• 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
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• Administration problems

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
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• 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.
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• 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.
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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?

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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.
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Data Collection
   
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• Social Worker Homevisit

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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
Palliative Care Ward
Discharge Planning Committee
Ward station
Case referral
Hospital
Homecare Support Service Centre in Hospital
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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
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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

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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

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• 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.

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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
Health Supports
Informal care supports
Older people
Neighbourhoods
Long-term Care Centre
Welfare service Supports
Fire Bureau
Welfare agencies
Police office
Religion Groups
Volunteers
Transportation
Local/Central Government
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• Older people receiving
• homecare service in
• Chung-Hwa county

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