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Taitung City's Elderly Care Service Organization Management and Network Analysis Report

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Taitung City's Elderly Care Service Organization Management and Network Analysis Report Taitung City’s Elderly Care Service Organization Management and Network Analysis Report Department of Politics and Public Administration The University of Hong Kong Department of Public and Cultural Affairs National Taitung University 20th August 2018 1 Executive Summary With the development and changes in the external global environment, aging population has become a pressing problem encountered by many countries in recent years. This issue covers various aspects such as the industrial economy, social culture, medical care and labour population whereas the problem is more severe in remote areas. The Government has been in a leading role to steer the development of social welfare in Taiwan. However, the complex global environment, ever-changing economic situation and an enhanced level of civic awareness have complicated the governance issue in which it is difficult for the government to deal with aging population alone. To cope with this problem, collaborative governance among the government, business corporations and nonprofit organizations is required. By integrating resources from and sharing responsibilities among the three parties, this can prevent public resources to be deployed in a duplicated manner which can lead to resource wastage amid limited resources. Until the end of 2015, the elderly population in the Taitung County has reached 14.42% of the County’s total population. This indicates that Taitung has become an aging society, ranking the third among Taiwan regions in terms of the severity of aging population. Aging population also brings about different social problems in Taitung, such as increasing demand for elderly care and medical services, issues of elderly person living alone and grandparenting. These problems are deteriorating and have become important issues that Taitung County must confront. To solve the growing aging population, Taiwan proposed a 10-year caretaking plan in 2005, aiming to prepare for the approaching aging society. In May 2015, Taiwan enacted the Long-Term Care Service Act. Since then, for those elderly persons who have been disabled for six months or above and in need of long-term daily-life and medical care services, their family members can employ trained professional caretakers through relevant caretaking authorities to provide the elderly person with proper care services on a family, community, or live-in basis. To ensure that the relevant elderly care service policies and ordinances are executed smoothly, how the service providers carry out the measures during the process is a significant factor in determining the effectiveness of the policies. This research targets at elderly care service providers in Taitung County. Through face-to- face interviews, the research investigates and understands the current situation of the development of long-term caretaking policies in Taitung County, the obstacles encountered and the direction of improvement. Moreover, the research probes into the organizational network among different departments in the elderly care service organizations. This research seeks to understand the situation and problems of elderly caretaking in Taitung County and make relevant policy recommendations. 2 Content Chapter 1: Introduction 4 Chapter 2: Research Background 5 2.1 Development of Long-term Care Policies in Taiwan 5 2.2. Geographical Characteristics and Elderly Population 6 Development in Taitung County 2.3 Introduction of the Elderly Care Service Providers 9 Development in Taitung County and its analysis Chapter 3: Research Design and Methodology 11 3.1 Sampling Method and Characteristics of Research Samples 11 3.2 Timeline of the Research Process 14 3.3. Research Method and Content 15 Chapter 4: Research Findings 16 4.1 Organizational Network among Elderly Care Organizations 16 in Taitung City 4.2 Discussion of Research Findings 17 Chapter 5: Conclusion 33 3 1. Introduction Until the end of 2015, 14.42% of Taitung County’s total population were elderly, which is having the third largest aging population in the whole of Taiwan. The large size of aging population in Taitung causes various social problems, including high demands for elderly care and medical services, elderlies living alone and grandparenting. In response to these problems, the national government has implemented a ten-year caretaking plan in 2005 and the Long-Term Care Services Act to provide direct care and medical services for the elderly, and indirect assistance to families with disabled elderly on a family, community and live-in basis. Nevertheless, these policies and legislations highly rely on the effective provision of social services by local agencies in order to be successful. It is therefore essential to examine the current development of elderly care service providers in Taitung, their projects and collaboration with other sectors – to determine whether services were efficiently planned and delivered to the elders in need. To study these issues, face-to-face interviews were conducted with 35 social service agencies in Taitung to under obstacles these agencies faced and their organizational network built up. Through collecting these data, this research seeks to understand the elderly service delivery situation and make relevant policy recommendations in this regard. 4 2. Research Background To deepen the understanding of long-term elderly caretaking in Taitung, this section is divided into two parts. The first part provides a basic background for the understanding of Taiwan’s long-term care policies. The second part delineates the current situation of elderly population in Taitung. 2.1 Direction of Taiwan Long-Term Care Policy – Aging in Place With the long-term care policies implemented in Taiwan, community care has become an important foundation in the provision of elderly services. A wide range of organizations are involved in carrying out community care in society, including local government, nonprofits, informal care systems, home care services, day care centres, disabled care and nursing service centres. The full support of these organizations in providing community care for the elderly reflects the policy intent of the Taiwanese government in promoting the concept of “Aging in Place”. “Aging in Place” has been a concept developed in the 1960s in the Northern Europe. It advocates for letting the senior citizens continue to stay in their local community as they age and their physical capability decline. This arrangement will be more beneficial to the elderly due to maintenance of their independence, self-respect, privacy and quality of life. This concept has become a guiding elderly care policy in may well-developed countries, namely Germany, Australia and Japan due to four major reasons: first, high educational level and economic statuses lead to elderly prefer home-based care services which ensure higher degree of independence. Second, professional caretaking concepts exist to make home-care services possible and institutional-based service is not the only option. Third, home-based services reduce government expenditure on elderly services and lastly, advanced medical development facilitates the widespread use of home-based services (Wu and Chuang, 2001). Nevertheless, in Taiwan the “Aging in Place” concept is not effectively implemented despite the government’s strong policy intent. Several inadequacies are discovered causing such ineffectiveness. First, there has been insufficient community- based care services to cater for the home-based elderly service demands (Wu and Chuang, 2001). Second, supply of institution-based services is much more prevalent than home-based services in Taiwan. Third, home-based care services are unaffordable for the elderly. Installation of care facilities at home costs more than half of the average monthly household income, which imposes a heavy financial burden on elderlies without support of government financial assistance. Hence, elderlies in Taiwan are still reliant on nonprofit organizations providing free or affordable social services to care for their daily needs. 5 2.2 Geographical Characteristics and Elderly Population Development in Taitung County According to the population projections between 2012 and 2060 done by the Council for Economic Planning and Development of the Executive Yuan in 2012 (Figure 1), since Taiwan has fulfilled the United Nations’ definition of aging society in 1993, it was projected that Taiwan would become an “aged society” and “hyper- aged society” in 2018 and 2025 respectively (Council for Economic Planning and Development, 2016). As aforementioned, the problem of aging population was a product of industrialization and urbanization. The gradual decline of the functions of today’s family and the low fertility rate have created a phenomenon that the proportion of the elderly population which requires the provision of social care services and social welfare is increasing while the proportion of productive population which are capable of supporting the elderly population is decreasing. The problem of aging population is imposing a heavier burden on society progressively. Figure 1: Trend of demographic changes in 1990 – 2060 Source: Population Projection of Taiwan from 2012 to 2060. Website of the Council for Economic Planning and Development (2016).http://www.cepd.gov.tw/m1.aspx?sNo=0000455 Furthermore, the problem of aging population is more serious in remote areas. In Taitung, the distance between its north and south ends is 176 km. Slope land and mountainous areas account for 96.68% of the total land area in
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