Addressing Challenges

 

Rapid Aging of Taiwanese Society Taiwan is experiencing a rapid aging of its population.

 

The United Nations classifies aging societies into three categories: aging society (with more than 7% of the population aged 65 and above), aged society (with more than 14% of the population aged 65 and above), and super-aged Society (with more than 20% of the population aged 65 and above). According to statistics from the National Development Council, Taiwan is about to enter a super-aged society by 2025. This implies that, by that time, the population aged 65 and above will constitute 20% of the total population. Without appropriate preparation, there is a looming risk of a long-term care crisis. Over the past decade, Taiwan has recorded nearly a hundred cases of caregiving-related homicides. In response, the Ministry of Justice issued a news release on February 7th this year, implicating leniency for those perpetrators deserving of compassion to be "pardoned." However, this does not provide a fundamental solution to the problem.

 

Analyzing the population structure across various counties and cities in Taiwan, Chiayi County stands out with the highest proportion of elderly individuals at 21.69%, followed by Taipei City at 20.91%, Nantou County at 20.13%, and Yunlin County at 20.12%. Statistically, the average duration of long-term care needed by Taiwanese citizens throughout their lives is 7.3 years. In the face of this aging population and a declining birth rate, "long-term care" has emerged as a critical issue that Taiwanese society must address, in addition to the challenges of birth, aging, illness, and death.

 

Long-Term Care 2.0: Insufficient and Unstable

 

Taiwan is proud of being an advanced nation, but it suffers significant shortcomings in long-term care funding, accounting for only 0.26% of its GDP, which falls far below the global average.

 

OECD member countries, on average, allocate 1.7% of their GDP to long-term care expenditure. Japan, a neighboring country, devotes 2% of its GDP to this purpose. Even before the elderly population reached 14%, Japan had passed the Long-Term Care Insurance Law in 2000, establishing "long-term care insurance." South Korea has rapidly increased its allocation in the last two years, reaching 1.1% of its GDP, more than four times that of Taiwan. Taiwan hasn’t institutionalize its long-term care system and relies on public budget allocations along with other funds. Last year, long-term care expenditure reached around NTD 60.7 billion, primarily from unstable sources of tobacco tax, house and land transactions income tax, and inheritance tax. As expenditures increase annually, the Long-Term Care Funds are projected to last only another five years.

 

Due to extremely limited funding, Taiwan's long-term care can only provide services for a select few, mainly focusing on mild cases rather than severed cases, with an overall coverage rate of only 67%. Many individuals with moderate to severe disabilities are unable to access services, and there is a shortage of nighttime care providers. Even those who employ foreign caregivers are excluded from the long-term care protection net. In July of this year, the Tsai administration raised the subsidies for those in residential long-term care institutions from NTD 5,000 to NTD 10,000. Vice president Lai Ching-te even advocates to further increase to NTD 15,000 per person per month. However, there is no corresponding financial sources have been secured. Does this mean more debt accumulation and a heavier burden on the next generation?

 

Foreign Caregivers Excluded from Long-Term Care Services

 

The existing long-term care system stipulates that households employing foreign caregivers cannot concurrently access Long-Term Care 2.0 services. Furthermore, numerous individuals with moderate to severe disabilities face difficulties in gaining admission to long-term care facilities. These challenges primarily arise from the significant financial burden associated with accommodation costs, limited institutional capacity, and inadequate facilities.

 

Some families opt to hire untrained foreign migrant workers to provide caregiving services, resulting in a multitude of societal problems. This practice not only affects the quality of care but also increases the burden on caregivers.

Presently, there are approximately 228,000 foreign caregivers in Taiwan. New Taipei City leads the list with 37,828 foreign caregivers, followed by Taipei City (36,940), Taichung City (23,978), Kaohsiung City (20,072), Taoyuan City (19,583), Tainan City (14,596), and Changhua County (11,365).

 

Current Issues with Long-Term Care 2.0 are as follows:

1. Unstable and Insufficient Funding: Long-Term Care 2.0 suffers from an unstable and insufficient source of funding.

2. Expenditure Falls Far Short of Advanced Nations: The expenditure on long-term care significantly lags behind that of advanced nations.

3. Reliance on Ad Hoc Public Budgets: The long-term care system heavily relies on ad hoc allocations from public budgets, lacking a stable institutional framework.

4. Prioritizing Mild cases Over Severe Cases: The system disproportionately caters to less severe cases, leaving families with moderately to severely disabled members outside the scope of care.

5. Exclusion of Severe Disabilities (Level 7 and Above): Individuals with severe disabilities, especially those classified as level 7 or higher, are unable to access institutional care due to reasons such as insufficient facilities and workforce, along with annual subsidies of only 120,000 NT dollars that render the cost unaffordable.

6. Inadequate Support for Primary Family Caregivers: Primary family caregivers do not receive sufficient support concerning their physical and economic well-being.

 

Solutions

 

Ko Wen-je advocates for Long-Term Care Insurance and Long-Term Risk Mitigation:

 

Capacity-Based Payment: Implement a capacity-based payment system that ensures higher financial adequacy, stability, affordability, and equitable benefits. This approach is better suited to meet the long-term care needs of the majority and is less susceptible to the effects of an aging population and economic fluctuations.

 

Enhanced Financial Accountability: Strengthen financial responsibility and oversight by members of society. This approach facilitates a more responsive system that is capable of meeting the long-term needs of citizens while raising public awareness of cost considerations.

 

Dr. Ko Wen-je emphasizes a collaborative approach between the government and the citizens to care for families:

 

1. Increase Long-Term Care Budget: Raise the long-term care budget from 60 billion NT dollars to 230 billion NT dollars, ensuring ample financial resources for comprehensive service delivery.

2. Establish the Central Long-Term Care Insurance Bureau: Create a specialized agency responsible for long-term care insurance and service oversight.

3. Raise Subsidies for Residential Long-Term Care Facilities: Increase subsidies for residential long-term care facilities from 10,000 NT dollars to 30,000 NT dollars, effectively alleviating the financial burden on families requiring long-term care services.

4. Inclusive Care for those who hire Foreign Caregivers: Extend basic long-term care insurance coverage to those who hire foreign caregivers, offering services such as home care, nighttime care, and family support for a more comprehensive protection system.

5. Quality Enhancement and Frequency Expansion: Expand and improve long-term care services to ensure a higher level of service quality and more frequent care provision.

6. Providing Cash Assistance for Family Caregivers: Provide financial assistance to family caregivers, acknowledging their efforts, reducing family conflicts and tragedies, and addressing economic challenges resulting from caregiving responsibilities.

7. Establishing PAC (Post-Acute Care) System: Create a Post-Acute Care system to alleviate the pressure on hospital beds and reduce overcrowding in healthcare facilities.