long-term care 2.0 in taiwan - respond to an aging society
TRANSCRIPT
Pau-Ching Lu, Ph.D.Deputy Minister, Ministry of Health and Welfare
Aug 30,20171
Long-Term Care 2.0 in Taiwan - Respond to An Aging Society
Ministry of Health and Welfare
Outline
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Conclusion
Background
• Current Status of LTC 2.0• Challenges and Strategy of LTC 2.0
Ministry of Health and Welfare
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Background
Ministry of Health and Welfare
1. Rapidly Aging Population
Note: Population figures after 2018 are estimated figuresData source:1. National Development Council (2016) Population estimate of Taiwan (2016-2061) , http://goo.gl/d4kckk2. Department of Statistics (2016) Monthly report of the Interior Statistics Jan-Nov, http://goo.gl/05L1A4 4
Aging Society
Aged SocietyAged
Society
Super Aged Society
Over 65years old
Over 75years old
Percentage of aging(65+) population (%)
23.5%4,323,000
38.9%7,152,000
14.5%3,434,000
20.6%4,881,000
13.2%3,108,000
7.1%1,490,000
2.1%445,000
5.6%1,327,000
5.9%1,399,000
7.9%1,881,000
Ministry of Health and Welfare
Average fertility rates of women in childbearing age in Taiwan
Changes in number of members in the household in Taiwan(person/household)
(person)
Data source: Ministry of Interior
2. Changes in Family Structure
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Changes in family structure resulted in less caregivers in the family– Average fertility rate is 1.18 persons, with number of members per
household at 2.77 persons
3.57
3.33
3.25
3.16
3.06
2.96
2.852.82 2.80
2.77
2.6
2.7
2.8
2.9
3
3.1
3.2
3.3
3.4
3.5
3.6
1994 2000 2001 2004 2009 2011 2012 2013 2014 2015
1.761.68
1.34
1.18
1.03
0.895
1.07
1.27
1.071.17 1.18
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
1999 2000 2002 2004 2009 2010 2011 2012 2013 2014 2015
Ministry of Health and Welfare
3.Profile of Older Adults
co-resident with children:59.9% Life expectancy: • All national: 79.84 years old• Indigenous people:71.60 years old
Disability rate• Older adults over 65:12.7%~16.3%• People with disability(aged 50 to 64):17.9%• People with disability (aged 5 to 49):13.8%
Prevalence of older adults with dementia: 8%
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Ministry of Health and Welfare
4.Overview of the Development of Long-term Care Policy
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2007 2015 2016 2026
Stage 1: Long-term Care Plan1.0
Stage 2: Long-term Care Service ACT
(The Long-term Care Services Act was promulgated by Presidential Order on June 3, 2015)
Source: Ministry of Health and Welfare ,R.O.C. (Taiwan)
Long-term Care Plan 2.0 (2017-2026)
2017
Ministry of Health and Welfare
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Current Status of LTC 2.0
Ministry of Health and Welfare
Missions and Goals of LTC 2.0
Missions
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Goals
1
Establish an accessible, affordable, universal long-term care service system with good quality.
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“Ageing in place”as policy goal
3 Upstream prevention to delay disability
4 Downstream preparedness to provide discharge plan, home-based medical care.
Continuumof
care
Person-centered
Community based
Ministry of Health and Welfare
Targeted population
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LTC2.0LTC1.0
Older people with functional limitations of ADLs (aged 65 and over)
Mountain indigenous people with functional limitations of ADL (aged 55 to 64)
People with disability (aged 50 and over)
Older people living alone with only limitations of IADLs(aged 65 and over)
People with Dementia (aged 50 and over)
Plain-land indigenous people with functional limitations (aged 55 and over)
People with disability (aged 49 and under)
Older people with frailty(aged 65 and over)
Expanded to include
Eligibility Criteria:1. Functional limitations2. Age
Ministry of Health and Welfare
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Hospital
City and county care management center
CommunityPeople with cognitive
impairment and/or disability
home-based medical care
The tasks of care managers:
Conduct needs assessment Determine benefit level and care plan for people with
disability and/or cognitive impairment Linkage servicesRegular reviews, monitor and quality control
Discharge plan service
Care Management
Ministry of Health and Welfare
Service Items
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Increased from 8 items to 17 items
(1) Care Services(2) Transportation Services(3) Nutrition Meals for the Elderly(4) Assistive Device Purchases/Rental and
Handicap-Friendly Improvements to Residences (Instances)
(5) Home Nursing (6) Home/Community Rehabilitation(7) Respite Care Services(8) LTC Institutions
LTC2.0LTC 1.0Service item 7 innovative and integrated services
(9) Dementia care services(10) Community integrated services in
indigenous region (11)Small-scale, multi-functional services(12)Family caregiver support services (13)Community comprehensive care
service system(14)Community preventive care(15)Programs to prevent or delay
disability
2 connected services(16)Discharge planning service(17)Home-based medical care
Ministry of Health and Welfare
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Constructing the comprehensive community care service system
A
C
B
C
B
Care management center
Meals and nutrition
Respite service units
Foster care home
Home nursing centers
Home-based and community rehabilitation
Assistive device resource centers
Transportation and pick up
Tier A – Community integrated service center Coordinate and link care service resources according to the care
plan designated by the care managers. Establish localized service delivery system that integrates and
connects to B-tier and C-tier resources. Pick up and transport service connecting A-B-C service through
community transport and care transport personnel
Tier B– Combined service center Elevate community capacity to provide LTC services Increase diverse services for the public
Provide respite service in the neighborhood Implement primary prevention programs
Tier C – LTC stations around the blocks
Goal:Create a comprehensive care system that integrates medical care, LTC services, housing, prevention, and social assistance to allow people with disability to receive the care they need within a 30-minute drive.
Ministry of Health and Welfare
Wan-Hwa District ,Taipei City (1A2B3C)
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Ministry of Health and Welfare
Xio De Lan LTC stations around the blocks
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Ministry of Health and Welfare
Develop Resources for Family Caregivers
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Establish family caregiver support service centers
1.Case management2.home care technique and training3.Care technique training course4.Respite service5.Support groups6. Destress activities7. Joint counseling8. Telephone outreach
Single contact window for all family caregivers. Telephone counseling is not only timely and convenient, and can provide services such as support, counseling, and welfare resource referral.
Family caregiver hotline 0800-507272
Current StatusService items
The Long-term Care Service Act was implemented in June, 2017. Its service target includes family caregivers.• Art. 9.1.(4)Family caregiver supportive services: Fixed-location and home supportive services provided to family caregivers.• Art. 13. The scope of supportive services
provided by family caregivers are defined as follows:
1. Provision and referral of relevant information2. Long-term care knowledge and technical training3. Respite care services4. Emotional support and referral of group services5. Other services that help promote the capability
of family caregivers and the life quality thereof.
Ministry of Health and Welfare
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Challenges and Strategies of LTC 2.0
Ministry of Health and Welfare
The slow growth of home-based and community-based services.
Collaboration between public and private sectors
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Challenge 1 Strategies
1.The special budget(block grants) are given to local government.
2.Provide incentives to organizationnot only limited to NPOs, all join in as service providers.
3. Giving priority to:(1) Expanding home-care services
supply(2) Increasing establishment of day
care centers.(3) Integrating multiple services.
Ministry of Health and Welfare
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Speed up the development of workforce
The shortage of long-term care workforce, especially the frontline direct care workers.
Challenge 2 Strategies
1. Improving employment conditions
2. Innovating job training
3. Advancing formal education to increase the supply of workers from young cohort
Ministry of Health and Welfare
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Elevating the efficiency of long-term care payments & benefits
Commissioning LTC services
Challenges Strategies
• Revision of the needs assessment tool
• The needs of LTC divided the needs of long-term care into 8 levels with evidence-based data
Need assessment: The assessment tool is mainly based on functional limitations of ADL
Payment for providers:fee-for service payment
The payment is paid in package and capitation for user –centered integrated services.
From “commission” to “contract”
Ministry of Health and Welfare
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Conclusion: Looking Ahead in Long-term Care Policy
Ministry of Health and Welfare
Conclusion1
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Sustainability of Financial System
Promote Quality
Collaboration among all stakeholders
Ministry of Health and Welfare
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Conclusion2
Through the LTC 2.0 We wish to
Establish community based long-term care systemAND
Provide accessible and affordable service with quality
Ministry of Health and Welfare
Thanks for your attention!
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