Presentation on theme: "Community Care Services for Older People in Taiwan University of Bath Social and Policy Sciences Dept. Ph.D student Ju-Huey Wen."— Presentation transcript:
Community Care Services for Older People in Taiwan University of Bath Social and Policy Sciences Dept. Ph.D student Ju-Huey Wen
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 GNP US $ 12,876 (2002) Population nearly 23 million Economic structure 1950 Agricultural exports 1960s & 70s Light manufacturing 1980s & 90s High technology and chemical product exports 1995~ Technology-intensive products Taiwan
1624Dutch & 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. 1895The Treaty of Shimonoseki concludes Sino-Japanese War; Taiwan is ceded to Japan. 1945Taiwan is retroceded to China after 50 years of Japanese occupation. 1949The central government of the Republic of China relocates to Taiwan, after the mainland falls to the Communists. 1947Due to bad administration, ethnic tension, and other factors, an islandwide uprising, known as the February 28 Incident, breaks out. 1996The 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. Chronology
Senior Citizens Welfare Law established in 1980 and then amended in 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. 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. Welfare Policies 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 (Ministry of Interior of Taiwan, 2003)
Changes of old age over 65 in Asian countries (Ministry of Interior of Taiwan, 2003)
Changes of old age over 65 in six countries (Da-Ho Liu,2001)
Old age population dependency ration/working and retired population ration in six countries Country Age(%)Old age population dependency Ration (%) Working population: Retired population (%) Age(%)Old age population dependency Ration (%) Working population: Retired population (%) 20~ ~6465+ Taiwan : :1 Japan : :1 Germany : :1 France : :1 UK : :1 USA : :1
Current Community Care Services A. Homecare ServiceB. Day Care Service 1. Housework Service Cooking, laundry, cleaning, grocery shopping C. Continue Education Programs 2. Paperwork Service Apply welfare services, pay bill, write letters for clients, help them read books or news. D. Recreation Centers 3. Medical Service Accompany older people to see a doctor, help them take medicine and take simple exercise E. Hotline Service 4. Emotional Support Service Talk to older people, emotional support, care about their health and lives, phone service F. Meal on Wheels 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)
(Ministry of Interior, 2003)
Lack of the quality management of social services Current Problems Lack of a welfare resource system support families with elderly members Fragmented community care services Administration problems
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 Ministry of Interior Elderly continuing education programs Social service agencies
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 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? 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?
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. Sampling
AreaTaipei CityChung-Hwa County Hau-Lien CountyTainan City Agency Wan-Hua Elderly Service Centre Chunghwa Christian Hospital Mennonite Social Welfare FoundationYMCA 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 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 Homevisi t Once13 timesOne day: 20 old peopleOnce homevisit Once hospital visit Meeting NoneTwice 1. Team meeting 2. Governmental meeting 3 times 1.Team meeting 2.Meals on wheels team meeting 3.Meeting for social worker licence exam Once: Team meeting Data Collection
Social Worker Homevisit
Clarify service area and process Case referral Volunteers supp ort Homecare service supervision Assess applicants for homecare service Homecare Service Support Center Department of Community Health Department of Social Work Hospital Local Government Head of Neighborhoods Social Work Association Welfare Agencies Other Homecare Service Support Centers Administration Division Case Referral Homecare Supervision Case referral Palliative Care Ward Discharge Planning Committee Ward station Long-term Care Center Case referral Service promotion Case referral Homecare Support Service Centre in Hospital Findings
Welfare Foundation Emergency support Case referral Meal provider Case referral Meals on wheels Service Homecare service Emergency notifying service Case workers Private Hospital (related to the Foundation) Administration Division Local Government Police Office Long-Term Care Center IT Company Head of Neighborhoods Case referral/ Financial support Resource sharing Case referral Resource sharing Annual/ monthly report Technique support Meal delivery Social workers refer cases/resource connection OT/PT for clients with stoke Public Health Center Private Welfare Agency Social Welfare Foundation in Hwalien
Coordination Joint meetings Understanding the roles of each profession Commitment on working together Clarify duty of each position Resources Government support/Donation/Clients pay for services Advantage of public agency and religious welfare agency Informal supports Volunteers resource connection system
1. Quality control Outcome evaluation unification of assessment system Clarify job duties Continuing training 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. Learning professional knowledge from each other will enhance communication and increase resources sharing.
Administration & Supervision of services Health Supports Welfare service Supports Informal care supports Head of neighbourhood/Administration Division Hospitals Public Health Centre Welfare agencies Volunteers Police office Religion Groups Fire Bureau Older people Long-term Care Centre Families & relatives Neighbour hoods Local/Central Government Dep. of Health/ Central Government Local/Central Government Local/ Centre Government Transportation
Older people receiving homecare service in Chung-Hwa county