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

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.

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

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.

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.

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 Taitung. These geographical characteristics have resulted in transportation inconvenience, thus leading to developmental impediments in Taitung. Second, the number of people living in Taitung City account for 45% of the County’s population. Taitung City is the geographical, population, political, economic and cultural centre among the 16 townships in Taitung County. Moreover, because of cultural differences and difficulties in making a living, citizens in Taitung City have a relatively lower income than those in other cities, thus they usually become the vulnerable groups. As their ages increase, the situation of poor elderly is more serious than in cities with high level of urbanization, which has become a universal phenomenon in remote areas.

6 Take the proportion of the elderly population in Taitung County as an example, table 2 indicates the trend of elderly population from 2001 to 2015 (Directorate- General of Budget, Accounting and Statistics, Executive Yuan, 2016). Since 2001, the proportion of elderly aged 65 or above is constantly high compared with other counties. After 2015, although the proportion of elderly in Taitung ranked behind Chiayi County (17.28%), Yunlin County (16.47%), Nantou County (15.21%), Penghu County (14.77%), Taipei City (14.76%) and Pingtung County (14.49%), the figure in Taitung County has already reached 14.42%, exceeding the threshold of 14% as an aged society. Together with the continuous decline of birth rate, the issue of aging population will be aggravated.

In addition, by comparing citizens’ disposable income in different cities and counties (Table 3) of the same year with Table 2, it is found that Taitung County’s disposable income has increased significantly, with credits to the county government’s active promotion of sightseeing tours such as hot air balloons. Taitung County’s disposable income improved remarkably in 2014 to 270.4 thousand Yuan and ranked above Changhua County (236.7 thousand Yuan), Chiayi County (241.1 thousand Yuan), Pingtung County (246.3 thousand Yuan), Yunlin County (256.2 thousand Yuan), Nantou County (258.3 thousand Yuan) and Tainan City (266 thousand Yuan). However, it should be noted that the long-term economic benefits of these sightseeing tours is still under observation but the continuous increase of the proportion of elderly and the vulnerable is of an inevitable trend.

7 Table 2 Proportion of Elderly Population Aged 65 or above in different cities and counties in Taiwan from 2001 to 2015 (Unit: %)

Source: Statistic Database, County Important Statistics Indicator, Directorate-General of Budget, Accounting and Statistics, Executive Yuan, R.O.C. http://statdb.dgbas.gov.tw/pxweb/dialog/statfile9.asp, 2016.

Table 3 Average Annual Per Capita Disposable Income in different cities and counties in Taiwan from 2001 to 2014 (Unit: Thousand Yuan)

8 Another point worth mentioning is that the Taiwanese aborigines in Taitung County comprise 35% of its total population. Until the end of 2014, there were around 31,477 elderly aged 65 or above in Taitung County in which 9,247 were Taiwanese aborigines, accounting for 29.4%. of the elder population. It is noted that Taiwanese aboriginal elderly in different regions and tribes have their own unique characteristics and differences. Therefore, the question of how to provide diversified welfare service according to their respective characteristics is a critical factor in analyzing the elderly problem in Taitung.

2.3 Introduction of the Elderly Care Service Providers Development in Taitung County and its analysis

With Taitung’s geographical constraints and cultural complexity, fewer elderly service agencies have entered this region and deliver social services. Nevertheless, two trends can still be discovered upon analyzing the current situation of service provision in this area:

(1) Basic medical and service needs provided by the public sector

Residents living in Taitung are mainly with lower educational level, work in primary and secondary industries and earn relatively low income. They are therefore reliant on public sector providing basic medical and elderly services when in need. Taitung Hospital, a public hospital located in southeast Taiwan, is established by the Ministry of Health and Welfare in 1986 in Taitung County to deliver affordable medical services for residents living in remote areas. It further collaborates with the Ministry and initiates the Medical Network Program, which provides disease screening, medical consultation and supplementary services to fill in the gap of insufficient public health services in the remote Taitung.

Medical services targeted at veterans and their families are also available in Taitung County, such as Malan Veterans Homes and the Taipei Veterans General Hospital. The latter is incorporated into the National Health Insurance Program to provide medical services for local residents in this region.

(2) Main service provision by religious nonprofit organizations

Religious nonprofit organizations play a vital role in the delivery of medical services to residents in Taitung. Both western and local religious organizations have contributed to set up branches to provide medical, education, elderly and childcare services.

Hospitals are the most important elderly care institutions established by these religious nonprofit organizations. Later, with increasing demands from the disadvantaged groups and increasing capacity of nonprofit organizations, service scopes of these hospitals have been broadened to include home-based care, nursing care, day care and rehabilitation bus services. These organizations are the major elderly service providers in Taitung to date; in particular, Taitung Christian Hospital, Taitung Mac Kay Memorial Hospital and Catholic Hualien Diocese Medical

9 Foundation Taitung St. Mary Hospital are the three most crucial medical units amongst all.

Table 4 includes a list of the organizations mentioned in the above two trends. For other local nonprofit organizations and small-scale care service institutions limited by the legal registration before 1999, they act as the secondary role in the provision of elderly services in Taitung.

Table 4 List of Medical and Elderly Service Organizations in Taitung County

3. Research Design and Methodology

The main purposes of this research are to examine the service profile and trend of elderly service organizations in Taitung City, investigate the network relationship among elderly service organizations and the impact of the relationship on the operation of the network.

3.1 Sampling Method and Characteristics of Research Samples

Taitung County is divided into 16 townships (Photo 2). Due to the long and narrow geographical distance between North and South, Taitung City has the largest population among the 16 townships, accounting for 45% of the total population in Taitung County. Also, most nonprofit organizations providing elderly care services are concentrated in Taitung City. Many of them have based their organizations in Taitung City and extended to other townships. Therefore, the research area of this study is defined in Taitung City.

Photo 2: Map of Taitung County from the Official website of Taitung County Government http://www.taitung.gov.tw/en/Default.aspx

In order to compile a comprehensive and systematic list of all the elderly service organizations in Taitung City, this research adopted different methods to collect relevant data collection and construct a database for elderly service organizations. In the early phase, Taitung County was set as the primary data collection scope. The different sources of information and their corresponding number of organizations found included: Internet searching for Taitung County’s elderly service organizations (32), list of registered elderly welfare organizations under the

11 jurisdiction of Taitung County (12), membership list of the Federation for the Welfare of the Elderly in Taitung County (7), Taitung County Social Welfare League (23), Organizations in charge of the community care centers in Taitung County (54), all Community Development Associations in Taitung County (153), Social Welfare Charity Foundations under the Department of Social Welfare of the Taitung County (6), Long-term care service contact list of the Public Health Bureau of Taitung County (57), referral units (126), Geographical map of long-term care resources (24) and telephone directory of Taitung County 2014 – 2015 (126). The total number of elderly service organizations found was 631.

Afterwards, all the elderly care organizations found in different sources were integrated and sorted according to their names. A list of elderly care organizations was compiled based on the designated screening principles (Table 5):

i. The organization is located in Taitung City: 291 elderly service organizations which are located outside Taitung City were excluded.

ii. No repetition of organizational names: 168 organizations were remained.

iii. Removed organizations which do not set elderly as their service targets and are recreational organizations but preserved organizations that are uncertain: 92 organizations were remained.

iv. Contacted uncertain organizations and removed those which do not provide elderly care services: 42 uncertain elderly care organizations were remained.

v. Lastly, together with Taitung County Elderly Association and Taitung City Elderly Association which provide more recreational services as the representatives, 42 elderly care organizations were identified.

Photo 3: Chart of Taitung City’s elderly care organizations’ data collection process

According to the above data screening procedures, the original sample size of 631 organizations identified was reduced to 42 elderly care organizations (Table 5) for interviews.

Table 5: List of Medical and Elderly Care Organizations in Taitung County

3.2 Timeline of the Research Process

This research was conducted from April 2015 to August 2016. The corresponding research process and schedule are shown in Table 6 on the following page.

14 Table 6 Research Process and Schedule

3.3 Research Method

This research employed face-to-face qualitative interviews as the main research method. Due to time constraints, some interview organizations filled in the questionnaires directly by themselves. Each interview lasted for around one to two hours. If the interview could not be finished within 2 hours, a second interview would be arranged so that the questionnaires could be completed. Moreover, the questionnaire interview includes the following parts:

i. Basic information of respondent ii. Basic information of organization iii. Organization’s individual network iv. Organization’s internal network structure v. Organization and community affairs vi. Organization’s performance evaluation vii. Opinion about long-term care policies

Before the interviews, respondents were required to sign the interview consent form. With the respondents’ consent, interviews were tape-recorded. After the interviews, written transcripts were made. If there were questions or incomplete parts, clarification and confirmation would be made through phone calls or emails in order to ensure the accuracy of the interview data and analysis.

15 4 Research Findings

4.1 Organizational Network among Elderly Care Organizations in Taitung City

Among the 42 aforementioned interview organizations, interviews with 35 of them were completed before 30th July 2016. The response rate is 83.33%. Those 7 organizations that failed to interview were Home care institution of Catholic Hualien Diocese Medical Foundation Taitung St. Mary Hospital, Taitung Aborigines Social Welfare Promotion Association, Catholic Hualien Diocese Medical Foundation Taitung St. Mary Hospital, Limited Liability Hualien Aborigines Second Care Labor Cooperative, Taipei Veterans General Hospital Taitung Branch, Ministry of Health and Welfare, Taitung Hospital and Home-base Nursery of Ministry of Health and Welfare of Taitung Hospital. The reasons for incomplete or rejected interviews are listed in Table 7.

Table 7 List of reasons for incomplete or rejected interviews

16 4.2 Discussion of Research Findings

According to the research findings from the 35 interviewed organizations, the analysis is divided into 7 parts: i. Basic information of respondents

The number of respondents in this research is 35. 14 are male (40.0%) and 21 are female (60.0%). The average age of the respondents is 51.9 years old and most of them are the middle and senior managers of the organizations. For education level, most of the respondents are university graduates. 23 respondents have university degree (65.7%) and 5 have high school degree (14.3%). For religious belief, Christianity is the most common. 11 respondents are Christians (31.4%). Daoism comes the second with 9 respondents (25.7%). This indicates that Christianity plays a very important role in providing Taitung’s elderly services. Lastly, the average length of service of the respondents in the corresponding organizations is 8.5 years.

Table 8 Basic information of respondents

ii. Basic information of organization

The organization’s basic information includes the attribute of the organization, service items, service clients and sources, income and expenditure etc. First, for organizations’ attribute, 13 are associations (society/ people-oriented) (37.1%), accounting for the largest proportion. In the second place, there are 9 private companies (25.7%). Besides, there are 5 religious nonprofit organizations (14.3%). Also, there are 4 organizations that are registered under specific laws to become statutory bodies and foundations (11.4%) respectively. This indicates that services provided by Taitung City’s elderly care organizations are mainly from society while the government provides a few.

In terms of the number of employees, most organizations have less than 60 employees. Those organizations which have more than 100 employees are Taitung Christian Hospital, Taitung Malan Veterans Home, Taitung Social Affairs Department Social Welfare Section and A Kernel of Wheat Foundation. The average number of employees in the organizations is 35.1.

For the main social function of the organizations, all organizations’ primary social function is to provide social services directly. Policy advocacy (37.1%) and providing chances for the public to participate in social affairs (22.9%) are the secondary functions. This suggests that elderly care organizations in Taitung do not set policy advocacy as their main purpose. This can be inferred from the fact that Taitung City is located in remote areas and most of the elderly are the vulnerable. Therefore, fulfilling the basic needs of the elderly becomes the chief mission and purpose of the organizations. Also, over half of the organizations’ main service recipients are the elderly (94.3%) and the disability (65.7%) welfare services. This is due to the fact that this research focuses on elderly care and most of the organizations serve elderly who are physically and mentally disabled.

18 Furthermore, for sources of income and expenditure, the first three main income sources are government subsidy (68.6%), subject pays (45.7%) and personal donation (34.3%). This reflects that Government is the primary source of income for elderly care organizations in Taitung City. Second, in terms of expenditure, the first three items are employee salary (68.6%), office and administrative expenditure (65.7%) and event expenditure (45.7%). This indicates that administrative personnel expenses are the largest source of expenditure.

19 Table 9 Basic information of organizations

iii. Organization’s network

The third part is about organization’s network. Respondents listed 10 organizations that his/her organization had cooperated with in the past one year and answered related questions.

Table 10 is the list of the cumulative number of organizational cooperation of the interviewed organizations. Among the top ten organizations cooperated, there are 5 governmental organizations, namely the Ministry of Health and Welfare of Taitung Hospital (listed for 12 times, ranked no.1), Taitung Social Affairs Department (listed 12 times, ranked no.1), Public Health Bureau of Taitung County (listed 8 times, ranked no.3), Taipei Veterans General Hospital Taitung Branch (listed 4 times, ranked no.4) and Taitung Social Affairs Department Social Welfare Section (listed 4

20 times, ranked no.4). Besides, there are religious nonprofit organizations in the top ten positions, such as Taitung Christian Hospital (listed 10 times, ranked no.3), Taitung Mac Hay Memorial Hospital (listed 10 times, ranked no.3), Home care institution of Catholic Hualien Diocese Medical Foundation Taitung St. Mary Hospital (listed 8 times, ranked no.3) and A Kernel of Wheat Foundation (listed 4 times, ranked no.4). Lastly, the remaining organization the Federation for the Welfare of the Elderly was listed 4 times and ranked no.4. The result of this part clearly indicates that there is close relationship among the development of elderly care organizations in Taitung.

Table 10 Organization’s network

21 iv. Organization’s internal network structure

For organization’s internal network structure, this part mainly analyzes the network relationship among organizations and their internal branches. Most of the organizations had no opinion for this topic. This can be interpreted that most of the interviewed organizations operate as a single organization and do not have internal network relationship. Only a few organizations have headquarters and branches.

First, in terms of the official and unofficial communication channels between the headquarter of the organizations and their internal branches, only 10 interviewed organizations (28.6%) have official communication channel and 2 interviewed organizations (5.7%) have unofficial communication channel which includes telephone, instant messaging (Line) etc. For the effectiveness of the communication, 13 interviewed organizations (37.1%) regarded the internal network as effective and very effective.

Table 11 Management and effectiveness of the organizations’ internal network

Moreover, in terms of the interviewed organizations and their affiliated organizations’ relationship, over half of the interviewed organizations (23 organizations) had no responses. There is around 30% of the interviewed organizations expressed “agree” and “very agree” with the statements respectively.

Table 12 Relations between interviewed organizations and their affiliated organizations

22 v. Organization and Community Affairs

In the perspective of organization and community affairs, almost all interviewed organizations admitted that they did not hold or participate in any advocacy events. Only the Taiwan Family Care Association expressed that they would initiate relevant advocacy events about the issues of “lack of home-base human resources, coordination problem of home case and case study”.

Secondly, in terms of whether the interviewed organizations participated in some government consultation mechanisms, main staffs or board members of 7 organizations (20%) were appointed as committee members of the Taiwan government. This includes the consultation meetings of Elderly Welfare Promotion Committee of the Ministry of Health and Welfare, committee members of Elderly Welfare Promotion Group of Taitung County, Age- Friendly Promotion Committee, Social Security Committee, Taiwan Long-term Care Professional Association and East District’s Medical Network of Clinical Environment for Physically and Mentally Disabled. Besides, 8 organizations (22.9%) noted that government officials had consulted them about some policies, including the Social Affairs Department and Department of Health of the Taitung County. 6 organizations (17.1%) have representatives in regional cooperative committees. They are the Elderly Welfare Promotion Committee, Federation for the Welfare of the Elderly, Committee of Taiwan Long-term Care Professional Association, Haiduan Township’s Long-term Care Promotion Committee, Taiwan Union of Nurses Association, Domestic Violence and Sexual Assault Prevention Committee and Medical Integration Committee. Also, 9 organizations (25.7%) made suggestions for some of the government policies, including letters from the Department of Health, suggestions and proposals submission, issue debate through committee meetings, direct meetings with relevant departments’ heads (Change of land category of agricultural land, extension of RehaBus), Meetings of issue debate, application requirement of the National Health Insurance, planning of the establishment of home-base care complain channel committee, communicate with Department of Health and meeting proposals (for respiratory services) and participation of seminars etc.

Table 13 Did the organizations participate in government advocacy mechanisms?

23 vi. Organization’s performance evaluation

In Part 6, to understand the strengths and weaknesses of the current performance of organizations, respondents were required to conduct assessment of their organizations’ performance and effectiveness. First, respondents were asked to rate their organizations in different areas, which are ways of service provision, sources of incomes, sources of expenditure, fulfillment of community/district needs, achievement of missions and overall performance. Among them, the average score of all respondents was the highest in the area of achievement of missions (8.91) and the area of overall performance came the second (8.45). It is followed by ways of service provision (8.34), sources of expenditure (8.17) and fulfillment of community/district needs (7.94). The lowest score is the sources of incomes (6.89).

Table 14 Organization’s effectiveness of performance

Secondly, in terms of the views of cooperation with other organizations (Table 15), for the statement “Your organization takes the initiatives to encourage knowledge exchange on providing effective services with other organizations”, 97.1% of the respondents chose the options of agree or very agree. For the statement of “Your organization believes other organizations can provide comprehensive help for your service targets”, 62.9% of respondents answered agree or very agree. Besides, 71.5% of respondents chose agree or very agree for the statement “Through cooperating with other organizations, your organization can better achieve your mission target”. These show that organizations have corresponding encouragement and knowledge exchange with other organizations. For the statement “Inter-organizational cooperation is one of the missions of your organization”, 77.2% of respondents answered agree or very agree.

However, for the statement “Your organization has internal policy and procedures to foster the cooperation with other organizations”, only 62.9% of respondents chose the options of agree or very agree. This indicates that although organizations cognitively understand the positive impacts of cooperation on the organization, there is still a gap for the organizations’ structural regulations. Furthermore, for the statement “Your organization has distributed staff time to inter- organizational work”, the percentage of respondents choosing the options of agree and very agree drops significantly to 31.4%. This reveals that although the importance of organizational cooperation is recognized, there are lack of strengthening of

24 structural regulations and lack of actual staff engagement in the actions involving organizational cooperation.

For the extent to which the organization’s services succeed in serving society’s needs in the past 5 years (Table 16), 88.6% of the interviewed organizations regarded that there was moderate and tremendous growth. Furthermore, organizations mainly perceived change in population structure (74.3%), regional economic environment (48.6%), unemployment (28.6%) and inflation (28.6%) as the fundamental factors contributing to the increase in the demand of community services. This indicates that demographic changes and economic factors have impacts on the increased demand of services from elderly care organizations.

For the changes within the interviewed organizations in the past 5 years (Table 17), the options of “staff salaries” (57.1%) and “number of target beneficiaries with provided services” (60.0%) are the most significant increase experienced by the organizations. It is followed by “internal training of staffs by the organization” (50.0%) and “number of staffs in providing services and working in related plans” (45.7%). The fifth and the sixth are “funding and sponsors from corporate institutions” (37.2%) and “number of staff in administration and support” (37.2%).

Lastly, to understand the interviewed organizations’ service plans, the following service plans are summarized in order to examine the situation and trend of different service provisions (Table 18). The main trends are:

(1) Does your organization provide the related services? (2) Does your organization participate or cooperate with other organizations in the community for the related services (including referral)? (3) Did your organization provide the related services but has now ceased? (4) Is your organization going to provide the related services in the short-term? (5) The organization does not provide the related services and is not planning to provide them in the short-term.

Among the interviewed organizations, 50% of them provide the relevant services, including “Purchase or rental of auxiliary equipment” (74.3%), “Long-term care service” (71.4%), “General assistance” (68.6%), “Free or subsidized transport service” (62.9%), “Elderly protection service” (65.7%), “Clothing” (51.4%), “Mentally disabled service” (62.9%) and “Free ride for the elderly and physically and mentally disabled” (62.9%).

Table 15 Views of cooperation with other organizations

26 Table 16 Extent to which organizations’ services succeed in serving society’s needs

Table 17 Changes in organizations in the past 5 years

28 Table 18 Service provision situation

29 vii. Opinion on long-term care policies

This part has 5 questions, which are open-ended about interviewed organizations’ views on long-term care policies. The questions are about the comprehensive and incomprehensive parts of elderly protection in Taitung, challenges and obstacles of the long-term care policies, the parts needed for improvement and ways of improvement, the collaborative relationships among different organizations and the most important cooperating projects among organizations. Firstly, respondents’ opinions on the comprehensiveness of Taitung City’s elderly social protection safety net can be categorized into two perspectives: reasons for its comprehensiveness and incomprehensiveness.

Table 19 Opinions towards Taitung City’s Elderly Social Protection Safety Net

Secondly, there are 13 integrated points of respondents’ opinions on the largest challenges and obstacles encountered by the long-term care policies.

(1) The long and narrow geographical condition of Taitung leads to insufficiency and uneven distribution of service resources. (2) There is a lack of staffs in long-term care services. Organizations’ beds are not open to residents for application. There are insufficient staffs in the provision of home-base services and this increases their workload.

30 (3) There are insufficient incentives to attract talents to be the service staffs. The professional image is not high. There is discrepancy between demands in job market and supply of graduates. Training is not uniform. (4) Currently relies on foreign workers heavily. This makes current and future situations succumb to difficulties. (5) There is a social phenomenon that those citizens who have the ability to take care of themselves are not willing to take the responsibility and depend completely on government subsidies. This leads to wastage of existing resources. (6) Private institutions, non-profit organizations and charitable foundations’ evaluations, standards and names are inconsistent. The improvement of the evaluation system wastes time and resources. (7) Future private organizations encounter transformation problems because of the lack of resources. (8) Long-term care information systems of the Department of Social Welfare and Ministry of Health and Welfare are inconsistent. (9) Resources of long-term care service and information of long-term care need to be integrated for industries’ participation in long-term care services. (10) Aging population in Taitung is becoming more and more serious. With the passage of the Long-term Care Services Act, the future long-term care services insurance will become citizens’ burden and this is hard to handle. In situations of insufficient financial resources of the government, the questions of how the government secures sufficient financial resources, how to provide citizens with comprehensive services after their insurance payments, how to improve the service quality, how to divide service recipients’ needs into community-based and institutional-based services and the problem of organizations’ future need to be addressed. It is of utmost importance for the government to solve the problem of insufficient financial resources for the execution of future social welfare policies. (11) Comprehensiveness of hardware facilities. (12) Insufficient organizational units. (13) Concept of “user pays” in social welfare services is weak.

Moreover, respondents pointed out the parts of improvement in the long-term care policies and how these problems can be addressed. There are a total of six points:

(1) Coordination and strengthening of policies in the long-term care systems of the Department of Social Welfare and Ministry of Health and Welfare. (2) Basis of evaluation needs to be integrated and policies should not be changing all the time. (3) There should be at least one service organization, one rural daycare organization and one community care organization to promote long-term care in remote areas with insufficient information. (4) Develop staff training. Salaries of the caretakers are relatively low and should be increased. (5) Government departments should review and develop improvement measures for the problem of high staff turnovers in care organizations. (6) Promotion and marketing of the policies should be strengthened so that citizens can receive information about relevant measures and service quality can be improved.

In terms of cross-departmental cooperation, interviewed respondents evaluated the adequacy of the cooperation relationship among government, corporations and non-profit organizations in long-term care policies with reasons provided. After compilation of the result of the interviews, there are four points:

(1) There are not many large-scale corporations in Taitung, insufficient resources in both corporations and government departments. (2) It is hoped that there is more participation from corporations to complement the insufficient parts of the government and non-profit organizations with the concept of social corporations. (3) The roles of government and community organizations are complementary. When the government promotes a policy, community organizations need to improve quality and professional service attitudes whereas the government performs a guiding role. When community organizations do not have sufficient resources, the government needs to provide professional assistance and guidance but not letting the community organizations to solve the problems by themselves. (4) It is hoped that an educated community can be promoted.

Lastly, there are five elements that the respondents perceived as the most important for cooperation between the interviewed organizations and other organizations.

(1) Sincerity (2) Provision of shared resources and expenditures, mutual visits and knowledge exchanges and possible transfer of resources to other organizations. (3) Combination of education and training with units providing courses so that human resources can be provided to society. For example, lifeguards and first- aid courses, caretaker training and disaster preparedness cooperation training. (4) Joint cooperation for the roles of advocacy and consultation on government welfare policies. This can also allow the direct transfer of information of government policies to other agents in a faster and more convenient manner. (5) Medical referral channels.

32 5 Conclusion

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 problem covers issues in different perspectives 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 in steering the development of social welfare in Taiwan. However, the complex global environment, ever-changing economic situation and 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 by the government, business corporations and nonprofit organizations is required. By integrating resources from and sharing the 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.

Although relevant policies and Ordinances have been legislated and implemented, 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 for improvement. Moreover, the research probes into the organizational network among different departments in the elderly care service organizations. As a result, this research seeks to understand the situation and problems of elderly caretaking in Taitung County and make relevant recommendations.

This research is a pioneer study of the network of Taitung’s elderly service organizations. It provides a preliminary understanding of the city’s elderly service profile, developmental processes of policies and network relations. At the same time, it is hoped that this research can act as a basis for future research for a deeper exploration of this issue and to provide recommendations for better elderly services and policies.

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